Coronavirus and Medicare: What You Need to Know

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Mary Kate Morrow
March 9, 2020

Coronavirus in the U.S.A is spreading fast. You cannot turn on the news today without hearing about coronavirus (COVID-19). The Center for Disease Control (CDC) has warned Americans that it is not a question of “if” coronavirus will spread to your area, but “when” it will. Medicare consumers should know how their coverage will cover coronavirus treatment as well as out of pocket expenses they could incur for treatment. Take a few minutes now to see if you should purchase Medicare supplements to help with out of pocket expenses or Medicare Advantage coverage instead of original Medicare.

What Is Coronavirus?

Coronavirus is a virus that causes respiratory illness and originated in Wuhan City, China. There have been more than 93,000 confirmed cases and 3,100 deaths worldwide. Coronavirus has spread internationally, with more than 500 cases reported throughout the United States.

What Are Symptoms of Coronavirus and Who Is Affected?

Symptoms of coronavirus may appear 2-14 days after exposure and include:

  • Fever
  • Cough
  • Shortness of breath
  • Breathing difficulties
  • More severe symptoms may include:
  • Severe acute respiratory syndrome
  • Lower Respiratory tract illness
  • Pneumonia
  • Kidney failure
  • Death

Everyone has the potential of contracting coronavirus. However, older people, people with weakened immune systems, and people with heart and lung disease are the most at risk of more severe symptoms or even death.

How Can I Protect Myself From Coronavirus?

As with any virus, you can take preventative measures to avoid contracting coronavirus, these include:

  • Regular handwashing with soap and water for at least 20 seconds
  • Using hand sanitizer with at least 60% alcohol to clean hands if soap and water are not available
  • Avoiding touching eyes, nose, or mouth with unclean hands
  • Avoiding close contact with infected persons
  • Wiping down commonly shared areas such as bathrooms or break rooms

You may be exposed to the virus if you are within six feet of an infected person, or through inhaling the respiratory droplets that are produced when an infected person coughs or sneezes. It is possible you can get sick from someone not showing symptoms, but primarily the virus is spread by people displaying symptoms. You may contract the illness through shared surfaces if you touch an orifice of your body such as your eye, nose, or mouth after touching an infected surface.

The CDC does not recommend that people who are well wear face masks. Face masks are recommended for people who show symptoms, healthcare workers and caretakers to help prevent the spread to others.

What Should I Do If I Contract Coronavirus?

If you suspect you have contracted coronavirus, you should seek immediate medical help. Call your healthcare professional if you develop a fever or cough or have difficulty breathing. You should also contact your healthcare provider if you may have been exposed to a person with coronavirus or you live in/have travelled to an area with a high concentration of infected people.

There are tests that will help your medical practitioner identify if your symptoms are in fact coronavirus. Once you have been diagnosed, your doctor may suggest:

  • Taking pain and fever medications
  • Drinking plenty of liquids
  • Staying home to rest
  • Taking a hot shower to ease sore throat and cough
  • Using a room humidifier to help with respiratory symptoms
  • Support for vital organ function in severe cases

How Will Medicare Cover Coronavirus?

Coronavirus testing will be covered by Medicare and Medicaid as a diagnostic test and essential health benefit of the program. If the coronavirus test was performed on or after February 4, 2020, you are covered. However, your provider will not be able to submit a claim for the test until April 1, 2020.

This news follows the announcement that the US Centers for Disease Control and Prevention will test any American for coronavirus subject to their doctor’s orders, and without restrictions. Their test will be provided free of charge to public health labs across the United States. The governor of New York has even ordered health insurers to waive all emergency room, urgent care and other health costs incurred by coronavirus treatment.

The Centers for Medicare and Medicaid Services (CMMS) proposed an allocation of $8.5 billion in funds for treatment and containment of the virus. On March 6, Donald Trump signed an $8.3 billion emergency supplemental bill to aid response to the coronavirus outbreak. More than $3 billion will go towards vaccine research, development and therapeutics. An estimated $2.2 billion is allocated towards preparedness and prevention efforts. An additional $1 billion will be used for purchasing medical supplies and supporting community health centers.

Will I Be Covered by Medicare if I Am Infected with Coronavirus?

The new emergency bill opens telehealth to people on Medicare if certain stipulations are met, removing the rule that usually restricts video services for people on Medicare. The Health Secretary implemented the telehealth provision to avoid filling doctors’ offices with infected patients and further spreading the coronavirus. Using telehealth should provide fast care and allow experts access to patients in a wider geographic area.

Many Medicare participants are subject to a $1,408 deductible, with coinsurance kicking in after the second month starting at $352 and gradually increasing over time. Considering the high-risk demographic of elderly and disabled people, Medicare recipients may want to consider buying Medicare supplement insurance for out of pocket costs, or a Medicare Advantage plan as an alternative to original Medicare.

What Has Medicare Traditionally Covered With Similar Symptoms?

To understand what may be covered for coronavirus treatment, it helps to look at conditions that require similar medical treatment.

Medicare covers comprehensive pulmonary rehabilitation programs for moderate to very severe chronic obstructive pulmonary disease (COPD). You’ll need a referral for pulmonary rehabilitation from the doctor treating your respiratory disease. If you receive these services in a doctor’s office, you are responsible for paying 20% of the Medicare approved amount.

In a hospital outpatient setting, you are additionally responsible for paying the hospital a copayment per session. Your deductible still applies, which you are responsible for paying before you receive financial assistance from Medicare or your prescription drug plan. Consider the fact that some Medicare Supplement insurance plans may pay 50% or more of the Part A deductible and part of the Part A coinsurance as well as hospital bills.

Coronavirus Out-of-Pocket Costs

If your doctor prescribes it for home-use, Medicare will cover the rental of oxygen equipment and accessories as durable medical equipment (DME). However, all of the following conditions must be met:

  • Your health improves with oxygen therapy.
  • Alternative methods have failed.
  • Your arterial blood-gas level falls within a certain range.
  • Your doctor says you have severe lung disease.
  • Your doctor says you are not getting enough oxygen.

Medicare may also pay for a humidifier, which may be used with your oxygen machine. Just as with COPD, you are responsible for paying 20% of the Medicare approved amount. Your deductible still applies, for which you are responsible for paying before you receive financial assistance from Medicare, your prescription drug plan, or any other insurances. Again, Medicare Supplements would help with these out-of-pocket costs.

Note that your out-of-pocket cost depends on many factors, including but not limited to:

  • Coinsurance
  • Facility type
  • Where you receive your test, item, or service
  • Doctor’s fees

Your doctor may recommend treatment that Medicare does not cover. Your doctor may also recommend receiving treatments more frequently than Medicare covers. In either of these circumstances, you may be responsible for some or all of the costs incurred. It is important to talk to your doctor about both why your doctor is recommending certain services as well as whether Medicare will pay for those services. Take a few minutes to research Medicare supplement insurance for out of pocket costs, and Medicare Advantage as an alternative.

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