Mega Doctor News
Medicare & Coronavirus
Coverage changes for COVID-19
• The Public Health Emergency for COVID-19 ends on May 11, 2023. After May 11, 2023:
• Medicare will continue to cover vaccines without cost sharing.
• You might have cost sharing for COVID-19 diagnostic tests.
• Medicare won’t cover over-the-counter (OTC) tests.
• Telehealth services will continue through December 31, 2024.
• Keep reading to learn more about these changes.
Get a COVID-19 vaccine as soon as you can.
- Medicare covers the updated COVID-19 vaccine at no cost to you. The updated vaccine targets the original COVID-19 viral strain and 2 Omicron variants (BA.4/BA.5). Medicare covers the vaccine for anyone who has Medicare. Be sure to bring your Medicare card.
- The updated Pfizer vaccine is available for people 5 and older.
- The updated Moderna vaccine is available for people 6 and older.
- Note: Some adults 18 years and older who have completed their primary vaccine series have the option to get a Novavax vaccine instead of the updated Pfizer-BioNTech or Moderna COVID-19 vaccine. Visit CDC.gov to learn more about the Novavax vaccine.
- If you:
- Already had at least 1 shot of the original COVID-19 vaccine but haven’t gotten the updated vaccine: You can get the updated vaccine at least 2 months later.
- Are 65 or older and got the updated vaccine at least 4 months ago: You can get a second shot of the updated vaccine.
- Are immunocompromised (like people who have had an organ transplant and are at risk for infections and other diseases) and got 1 shot of the updated vaccine at least 2 months ago: You can get a second shot. Your health care provider can determine if and when you should get additional shots of the updated vaccine.
- COVID-19 vaccines are safe and effective. Get details about the vaccine.
- If you have Medicare and have a disability or face other challenges in getting to a location away from home for a vaccination, Medicare will pay a doctor or other care provider to give you the COVID-19 vaccine in your home. You might need to give them your Medicare Number for billing, but there’s still no cost to you for the vaccine and its administration. Get details about the vaccine at home.
Medicare covers items & services related to COVID-19
- FDA-authorized and FDA-approved COVID-19 vaccines. You pay nothing out-of-pocket.
- Lab tests for COVID-19. You pay nothing out-of-pocket before the public health emergency ends on May 11, 2023.
- COVID-19 Over-the-Counter (OTC) tests. Read the section below for details.
- Oral antivirals. If you test positive for COVID-19 and have mild to moderate symptoms, but are at high risk for getting very sick from COVID-19, you may be eligible for oral antiviral treatment. Medicare Part D covers oral antiviral treatment. Your plan’s deductible, copayment, and coinsurance rules apply.
- FDA-authorized COVID-19 antibody (or “serology”) tests if you were diagnosed with a known current or known prior COVID-19 infection or suspected current or suspected past COVID-19 infection.
- Monoclonal antibody treatments for COVID-19.
- All medically necessary hospitalizations. This includes if you’re diagnosed with COVID-19 and might otherwise have been discharged from the hospital after an inpatient stay, but instead you need to stay in the hospital under quarantine. You’ll still pay for any hospital deductibles, copays, or coinsurance that apply.
- Expanded telehealth services through December 31, 2024.
Military hospital ships and temporary military hospitals don’t charge Medicare or civilians for care. If you aren’t sure whether the hospital will charge you, ask them.
- If you’re in a Medicare Advantage Plan, you might have access to these same benefits. Check with your plan about your coverage and costs.
COVID-19 Over-the-Counter (OTC) tests
Medicare covers up to 8 over-the-counter COVID-19 tests each calendar month, at no cost to you, until the Public Health Emergency ends on May 11, 2023.
- Medicare Part B (Medical Insurance) will cover these tests if you have Part B. (Medicare won’t cover over-the-counter COVID-19 tests if you only have Medicare Part A (Hospital Insurance) coverage, but you might be able to get free tests through other programs or insurance coverage you may have.)
- If you’re in a Medicare Advantage Plan, you won’t get this benefit through your plan, but you’ll get it through Part B.
- You might need to show your red, white, and blue Medicare card to get your free over-the-counter COVID-19 tests (even if you have another card for a Medicare Advantage Plan or Medicare Part D plan).
Get the covered tests at any participating eligible pharmacy or health care provider at no cost to you, even if you aren’t a current customer or patient.
Are there other ways I can get COVID-19 tests?
Medicare covers COVID-19 tests you get from a laboratory, pharmacy, doctor, or hospital, and when a doctor or other authorized health care professional orders it. You can also get up to one lab-performed test during the COVID-19 Public Health Emergency without an order, at no cost to you.
Some Medicare Advantage Plans might cover and pay for at-home over-the-counter COVID-19 tests as an added benefit. Check with your plan to see if it will cover and pay for these tests. Even if you get a test through your plan this way, you can still access up to 8 tests a month until the Public Health Emergency ends on May 11, 2023, through Medicare Part B, apart from your Medicare Advantage Plan.
If you paid to get a COVID-19 vaccine
When you get a COVID-19 vaccine, your provider can’t charge you for an office visit or other fee if the vaccine is the only medical service you get.If you get other medical services at the same time you get the COVID-19 vaccine, you may owe a copayment or deductible for those services.
If you paid a fee or got a bill for a COVID-19 vaccine, check this list to see if your provider should have charged you:
- Check the receipts and statements you get from your provider for any mistakes.
- Call your provider’s office to ask about any charges you think are incorrect. The person you speak to may help you better understand the services you got, or realize they made a billing error.
- If you have Original Medicare, review your “Medicare Summary Notice” for errors. Report anything suspicious to Medicare by calling 1-800-MEDICARE (1-800-633-4227).
- If you have other coverage like a Medicare Advantage Plan, review your “Explanation of Benefits.” Report anything suspicious to your insurer.
If you think your provider incorrectly charged you for the COVID-19 vaccine, ask them for a refund. If you think your provider charged you for an office visit or other fee, but the only service you got was a COVID-19 vaccine, report them to the Office of the Inspector General, U.S. Department of Health and Human Services by calling 1-800-HHS-TIPS or visiting TIPS.HHS.GOV.
Be alert for scammers trying to steal your Medicare Number
Only share your Medicare Number with your provider when you get COVID-related services.
As always, guard your Medicare card like a credit card and check Medicare claims summary forms for errors. If someone you don’t know calls asking for your Medicare Number, hang up.
How to stay up to date
- CDC.gov/coronavirus has the latest public health and safety information from CDC and for the overarching medical and health provider community on COVID-19.
- USA.gov has the latest information about what the U.S. Government is doing in response to COVID-19.
Information Sources: U.S. Department of Health and Human Services & Medicare.gov
