As the U.S. enters its second year of the coronavirus pandemic, the country has conducted more than 360 million tests for COVID-19 and continues to roll out millions of vaccines. It hasn’t been seamless — about 1 in 6 people who are 65 and older tried and failed to sign up for a vaccine, according to a recent report from the Kaiser Family Foundation. Of older adults who successfully got vaccinated or tried to sign up, about 4 in 10 said it was difficult.
For the 61 million Americans insured through Medicare and Medicare Advantage plans, vaccines and tests for COVID-19 fall under their Medicare coverage, but details can be hard to pin down. Since the start of the pandemic, the Centers for Medicare & Medicaid Services, or CMS, has adapted Medicare rules to handle needs related to COVID-19. Here’s a quick rundown:
Does Medicare cover COVID-19 testing?
Yes, Medicare Part B (medical insurance) covers all costs for tests to see whether you have COVID-19. You don't need an order from a doctor, and you’re covered for tests you get from a laboratory, pharmacy, doctor or hospital. And in some cases, a home health nurse, lab technician or trained medical assistant may be able to administer a test to you at home. If you have a Medicare Advantage plan, it’s required to cover everything that Medicare Part A or Part B would cover.
This coverage includes:
Tests to diagnose or help diagnose COVID-19.
Some tests for related respiratory conditions to help diagnose COVID-19, done together with a COVID-19 test.
Tests at some parking lot locations.
If you were diagnosed with COVID-19 or it’s suspected that you’ve had COVID-19, Medicare Part B will also cover COVID-19 antibody tests authorized by the Food and Drug Administration. Also called serology tests, these tests may indicate whether you’ve developed an immune response to COVID-19.
Medicare and Medicare Advantage cover all costs for COVID-19 tests and COVID-19 antibody tests, including copays, deductibles and coinsurance.
Does Medicare cover COVID-19 treatment costs?
Yes, Medicare covers a variety of treatment costs related to COVID-19. For instance, Medicare will cover monoclonal antibody treatments, in which people who've tested positive for COVID-19 with mild to moderate symptoms are given antibodies made in a laboratory.
Medicare will also cover required hospitalization due to COVID-19, including any days when you would normally have been discharged from inpatient care but have to stay in the hospital to quarantine. For hospitalization, you’ll be responsible for any hospital deductibles, copays and coinsurance that apply.
In 2021, for instance, if you have Original Medicare, you’ll pay a Part A deductible of $1,484 before coverage kicks in for the first 60 days of a hospital stay, unless you have supplemental insurance (or Medigap) that covers your deductible. If you have Medicare Advantage, your deductibles, copays and coinsurance will vary by plan.
Does Medicare cover the COVID-19 vaccine?
Yes, Medicare covers all costs for vaccine shots for COVID-19. There's no deductible, copay or administration fee. Be sure to carry your Medicare card or Medicare number — even if you’re enrolled in a Medicare Advantage plan — so the medical provider or pharmacy can bill Medicare. If you have Medicare Part B and have to fill out a form to get the vaccine, leave any “group number” field blank or write “N/A.”
Medicare Advantage plans are required to provide all the same benefits as Medicare Part A and Part B, and they may offer additional benefits, so check your specific plan for details.
To find out more about vaccines in your area, contact your state or local health department or visit its website. The VaccineFinder from the Centers for Disease Control and Prevention has a drop-down list of states and territories that will send you to the correct site.
If you have questions about Original Medicare coverage or costs, contact Medicare at 800-633-4227 or visit Medicare.gov.