Because the Department of Health and Human Services designated this test a health necessity, both government insurance plans must pay for the test if the patient is suspected of having the virus. However, a healthcare provider must order that test – you cannot just go to a testing site. Furthermore, the test must be done after February 4, 2020. If you received the test before then, you may not have coverage.
Medicare and Medicaid Provide Coverage for Preventative Testing and Screening
Like most insurance plans, Medicare and Medicaid both offer coverage for preventative screening and testing services. For example, your annual physical is considered a preventative screening, just like having regular mammograms can be. Now that COVID-19 testing is designated as a preventative test, it is covered, because these insurance programs cover any procedure designed specifically to prevent, find, or manage a medical condition.
Will I Pay for the Test at All?
For Medicare Part B recipients, you pay nothing to have the test. Also, if you are on Medicaid, you will be covered and the test is free.
Medicare Part B recipients do not pay any coinsurance or deductibles. Normally, you do have a $198 deductible and 20 percent coinsurance, but this was waived by the federal government as part of the Families First Coronavirus Response Act. The law also removed cost-sharing for those with Medicare Advantage plans.
What If I Test Positive?
It is no secret that older individuals, and those with underlying health conditions, are at high risk for complications from coronavirus. Most individuals on Medicare fall into that category, and a vast majority of those on Medicaid as well.
Right now, there is no treatment for coronavirus; therefore, once you test positive, there is not a medication you will be prescribed. However, your physician can treat the symptoms. Outpatient care is handled similarly to any other illness by both Medicare and Medicaid.
If you are hospitalized and have Medicare, you are covered for inpatient stays including being moved to a long-term care facility while you recover from COVID-19 under Part A. Outpatient treatments and services are handled by Medicare Part B. If you need an extended nursing home stay or in-home care, however, Medicare does not cover these and you will need to pay for them yourself.
While the test itself is free, cost-sharing resumes for all treatment. However, you do not have to pay for any quarantine stays in the hospital. Some Medicare Advantage plans may reduce the cost share or waive it entirely for coronavirus treatment. However, companies offering these supplemental plans are not required to waive those fees, and it is entirely up to the insurer that offers it. You will want to check with your Advantage plan supplier to see if they have waived that cost-sharing or any deductibles.
Will a Coronavirus Vaccine be Covered?
As of right now, there is no vaccine, but companies are working tirelessly to create one. Therefore, you may wonder if the vaccination would be covered once it is approved.
Just like other preventative vaccines, such as your seasonal flu vaccination, the coronavirus vaccines would be covered and you should not pay any deductible or coinsurance because it is a preventative health measure. In a provision of the CARES Act, the vaccines are free under Part B for Medicare and under Medicaid insurance programs with no deductible or cost-sharing applied. The same goes for if you have a Medicare Advantage program.
Can You Use Telehealth for Treatment?
Telehealth, initially, was not accessible for those with Medicare and Medicaid. But because coronavirus is deemed a public health emergency, the CARES Act waived the restrictions initially in place that barred you from receiving care over the phone. Now you can receive telehealth services, but you will still need to receive them from a federally qualified health center. You can also do your normal office visits and mental health consultation sessions during the pandemic as part of the CARES Act waiver.
Planning Ahead for Long-Term Care
While Medicare and Medicaid are both offering coverage for the pandemic, coronavirus is not the only health concern out there. Now is the time to plan ahead for the unknown. Those who were not prepared for COVID-19 found out how quickly their life changed when they could not work, had to pay for medical services, and were unable to receive the care they need.
Whether you need long-term care now or you just want to plan for the future, the best thing you can do is start creating your estate plan. An estate plan, done alongside a qualified estate planning attorney, can include long-term care plans. Medicare does not cover extended nursing home stays or in-home care; therefore, you need to financially plan for these. Furthermore, you may want to start the process of planning for Medicare now rather than when you are finally in need of it. Medicare restrictions are complicated, change regularly (based on income changes each year), and you want to make sure that when you turn 65, you can get medical coverage.
Speak with an Estate Planning Attorney Today
If you would like to plan ahead and make sure you have the coverage you need when the time comes, now is the perfect time to get started with estate planning. The Law Office of Andrew M. Lamkin, P.C., can assist you with your estate plan. Whether you want to adjust your existing plan and prepare for Medicare, or you want to set aside funds to pay for long-term care, he can assist you.
Making plans now ensures that, when the unknown happens in the future, you are ready to tackle them.
If you do not have an estate plan, now is the perfect time to get started. Even during coronavirus shutdowns, you can schedule a video conference consultation or teleconference with our team. Call us directly today to set up your time or request more information online.
Andrew Lamkin is principal in the law firm of Andrew M. Lamkin, P.C., where he focuses his practice in the areas of elder law, estate planning and special needs planning, including Wills and Trusts, Medicaid planning, estate administration and residential real estate transactions. He is admitted to practice law in New York and New Jersey.
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