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Toni: I must have missed this when listening to the national media coverage of the Coronavirus, but no one has explained how Medicare is covering the testing, vaccinations or quarantined in a hospital if anyone in my family that is on Medicare becomes infected with the virus.
My husband and I have recently retired and are covered by Original Medicare with a Medicare Supplement and a stand-alone Medicare Part D plan. Our parent’s situations are different as they both are covered by Medicare Advantage plans. My parents are both Texas retired teachers covered by TRS Medicare Advantage plan and my husband’s parents are covered by his father’s employer retiree Medicare Advantage plan.
How will Medicare pay for these different situations? I’d like to know what to do if I must take one of my family members or myself to the doctor or hospital. Thanks, Sheila from Bellaire, TX.
Sheila: We are witnessing a healthcare crisis that no one can be sure if they are safe. Especially the 60+million Medicare beneficiaries frightened of COVID-19, the disease caused by Coronavirus.
Let me discuss the various ways that Medicare will cover the testing and medical care for the 2 different Medicare plans…Original Medicare and Medicare Advantage plans:
- Original Medicare with Stand-alone Part D and COVID-19 (Coronavirus) testing began on or after February 4, 2020. You will pay nothing for Medicare covered clinical diagnostic laboratory testing provided. Your medical provider will have to wait until April 1, 2020, to be able to submit a claim to Medicare for this test. **it is very important to verify that your Medicare facility, provider or medical professional is accepting Medicare assignment for Medicare to pay for COVID-19. When a vaccine is available for the Coronavirus, then all Medicare Part D plans will carry the vaccine and copays may apply. Telehealth is offered with Original Medicare. Medicare Part A (In-patient Hospital) and Part B (Medical Benefit) deductibles and copays may apply.
- Medicare Advantage plan with Medicare Part D and COVID-19: Medicare beneficiary will have access to the same Medicare benefits. Medicare allows Medicare Advantage plans to waive cost-sharing for COVID-19 lab tests. Check with your Medicare Advantage plans to verify your coverage and costs. Telehealth coverage and additional coverage maybe offered. Once a vaccine for COVID-19 is available, then Medicare Advantage Prescription Drug plan copays apply. It is advised that the medical provider or facility be in network to receive your lowest cost for medical and vaccine costs.
Sheila, after April 1 when the medical community that is accepting Medicare assignment begin to file claims regarding COVID-19 (Coronavirus), then we will really know how claims will be paid. Remember accepting Medicare assignment and not just billing Medicare is the key to how a COVID-19 claim will be paid. Since you and your husband are covered by Original Medicare with a Medicare Supplement and stand-alone Medicare Part D, you may pay a certain amount for your claim and your parents which are both covered by a Medicare Advantage plan with Part D may pay a completely different amount or co pays because these are two different types of Medicare plans.
For questions regarding the maze of Medicare, call the Toni Says® Medicare hotline at 832-519-8664.
Toni King, author of the Medicare Survival Guide® is giving a $5 discount on the Medicare Survival Guide® Advanced book to the Toni Says Medicare column readers at www.tonisays.com.