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The COVID-19 public health emergency expires May 11, 2023.
Medicare will no longer provide free over-the-counter COVID-19 tests.
COVID-19 vaccines, laboratory testing, drugs and treatment are still covered.
Medicare Advantage members might have some new out-of-pocket costs for COVID tests.
The COVID-19 public health emergency, or PHE, expires May 11, 2023. That expiration means some changes for how Medicare covers services related to COVID-19.
The biggest change is that free at-home COVID tests will no longer be available. Vaccines, laboratory testing, medications and treatment for COVID-19 are still covered, but you might have to pay out-of-pocket costs or get a doctor’s order where you didn’t before.
Here’s a quick rundown of how Medicare covers COVID-19 testing, treatment and vaccines with the expiration of the PHE.
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Does Medicare cover COVID-19 testing?
Yes, Medicare Part B (medical insurance) covers all costs for clinical laboratory tests to detect and diagnose COVID-19, including copays, deductibles and coinsurance. However, there are more restrictions on coverage with the end of the PHE.
Medicare will now cover only tests done by a laboratory when they’re ordered by a doctor or health care provider. (During the PHE, you could get one laboratory test per year without a doctor’s order.)
Medicare also covers antibody tests, which can detect whether you’ve recently had COVID-19. As with the diagnostic tests, they’re covered only when you get them from a laboratory with an order from a medical provider.
With the expiration of the PHE, Medicare Advantage plans are still required to cover clinical laboratory tests to detect and diagnose COVID-19, but they might now have out-of-pocket costs.
Over-the-counter at-home COVID tests
No. This is a change with the expiration of the PHE.
During the public health emergency, Medicare Part B and Medicare Advantage members could get at-home COVID-19 tests for free. This benefit has ended.
Some Medicare Advantage plans might continue to offer over-the-counter tests as an added perk, but they’re not required to do so.
Does Medicare cover COVID-19 treatment?
Oral antiviral drugs
Yes, Medicare Part D (prescription drugs) covers oral antiviral COVID-19 drugs such as Paxlovid when prescribed by a doctor. It's still covered following the expiration of the PHE. Check with your plan to see what your out-of-pocket costs would be.
Monoclonal antibody treatments
Yes, Medicare Part B covers monoclonal antibody treatments, which can help prevent hospitalization for people who've tested positive for COVID-19 with mild to moderate symptoms.
Original Medicare will continue to cover monoclonal antibody treatments with no out-of-pocket costs through the end of 2023 if you test positive for COVID-19. In 2024, monoclonal antibodies will be covered if you have COVID-19 symptoms.
Medicare Advantage plans are required to cover all medically necessary Medicare Part A and Part B services. If you have a Medicare Advantage plan, you're covered for medically necessary monoclonal antibody treatments.
Hospitalization for COVID-19
Yes, this coverage is unchanged with the expiration of the PHE. Medicare covers 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.
For instance, if you have Original Medicare, you’ll pay a Part A deductible of $1,600 in 2023 ($1,632 in 2024) before coverage kicks in for the first 60 days of a hospital stay unless you have Medicare Supplement Insurance, or Medigap, that covers your deductible.
If you have Medicare Advantage, your deductibles, copays and coinsurance will vary by plan.
Telehealth services for COVID-19
Yes, Medicare has expanded coverage for telehealth services during the COVID-19 pandemic. The telehealth expansion will last until the end of 2024.
If you use telehealth services for care related to COVID-19, you may be responsible for deductibles or coinsurance. In some situations, health care providers are reducing or waiving your share of the costs.
If you have a Medicare Advantage plan, check if your plan offers additional telehealth services.
Does Medicare cover COVID-19 vaccines and boosters?
Yes, Medicare covers all costs for vaccine shots for COVID-19, including booster shots. This coverage is unchanged with the end of PHE.
There's no deductible, copay or administration fee. If you get your vaccine at a provider’s office, they can't charge you for the visit, unless you had other health care services at the same time.
If you require an at-home vaccination, there's no charge for the vaccination or the shot administration.
How to get your vaccine or booster
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.”
To find out more about vaccines in your area, contact your state or local health department or visit its website. Vaccines.gov from the Centers for Disease Control and Prevention can also help you find a nearby site offering the right vaccine or booster for you.
If you have questions about Original Medicare coverage or costs, contact Medicare at 800-633-4227 or visit Medicare.gov.
» MORE: What's new for Medicare in 2023?
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