Medicare provides critical benefits related to COVID-19, including the life-saving vaccine at no cost.
Coverage is also available under Medicare for telehealth and e-visits, which allow you to seek medical advice without an in-person visit.
If you get seriously ill from COVID-19, home health care is an important Medicare-covered benefit that can support you during recovery.
Wondering about Medicare and COVID coverage? As the pandemic continues its course, it can be hard to keep up with the rapidly changing guidelines. NCOA wants to keep you armed with the latest information on COVID-19 so that you can do all you can to stay healthy. If you’re a Medicare beneficiary, this guide can help you understand what is covered and when.
Does Medicare pay for the COVID-19 vaccine?
Medicare covers the COVID-19 vaccine at no cost to you. There is no copayment or deductible, and the vaccination provider cannot charge an administration fee. If you visit your doctor and the vaccine is the only medical service you receive, you should not be charged for an office visit.
If you’re considered immunocompromised (i.e., at higher risk for COVID-19 complications), Medicare will cover an additional dose of the vaccine at no cost to you. This extra dose should be given at least 28 days after your second dose of the Pfizer or Moderna vaccine and should match the vaccine you received for your first two doses. Currently, there are no immunocompromised doses available for the Johnson & Johnson vaccine.
If you're a Medicare beneficiary with a disability or are otherwise unable to visit a vaccination site, Medicare will cover the cost of having a healthcare professional administer the COVID-19 vaccine at your home.
Booster shots: Medicare also covers COVID-19 booster shots at no cost to you. You have the ability to choose which vaccine you receive for your booster. The recommendations are as follows:
- If you’re 65 or older (or at least 18 with elevated risk for COVID-19 complications) and initially received the Pfizer or Moderna vaccine, you can get a booster shot at least 6 months after you receive your second dose of the two-part vaccine.
- If you’re at least 18 and received the Johnson & Johnson COVID-19 vaccine, you can get a booster shot at least 2 months after your shot.
Find a COVID-19 vaccination site near you.
There are many COVID-19-related scams that target vulnerable seniors—so be aware. If someone tells you they need your Medicare Number in order for you to access the vaccine, it's likely a scam. Never share your personal information with a person who promises you vaccination in exchange for payment.
Does Medicare cover PCR testing?
Under Part B (Medical Insurance), Medicare covers PCR and rapid COVID-19 testing at different locations, including parking lot testing sites. There is no cost to you if you get this test from a doctor, pharmacy, laboratory, or hospital. You do not need an order from a healthcare provider.
Medicare Part B also covers antibody (serology) testing if you were diagnosed with COVID-19 or you are suspected to have had COVID-19 previously.
Does Medicare pay for COVID-19 treatment?
Medicare Part D covers any prescription drugs used to treat COVID-19. If you have COVID-19 and are experiencing mild to moderate symptoms, FDA-approved monoclonal antibody treatments can help prevent you from being hospitalized. Medicare Part B covers monoclonal antibody treatment if:
- you’ve been diagnosed with COVID-19 through a positive test,
- your symptoms are mild to moderate, or
- you’re considered high risk for developing severe COVID-19.
If you receive this treatment from a Medicare provider or supplier during the COVID-19 Public Health Emergency, there is no out-of-pocket cost to you.
In December 2021, the U.S. Food and Drug Administration (FDA) provided emergency use authorization for Paxlovid™ (Pfizer) and molnupiravir (Merck) for the treatment of mild-to-moderate COVID-19 in persons who are at high risk for progression to severe COVID-19, including hospitalization or death. Both medications are oral pills and will be available by prescription only. These medications should be started as soon as possible after diagnosis of COVID-19 and within five days of symptom onset. It is anticipated that these treatments will be covered by Medicare. Please note that these treatments are NOT a substitute for vaccination in individuals for whom COVID-19 vaccination and a booster dose are recommended.
Medicare and COVID-19 hospitalization
Medicare Part A (Hospital Insurance) covers any medically necessary hospitalization related to COVID-19. It even provides coverage if you’re diagnosed with COVID-19 during an unrelated inpatient stay and must remain in the hospital under quarantine. You will still be responsible for any deductibles, copays, or coinsurances that apply to your hospital stay. Medicare also pays for Veklury® (remdesivir), an FDA-approved medication given to certain hospitalized patients with COVID-19.
Virtual healthcare services coverage
If COVID-19 cases are on the rise in your community, the idea of visiting your doctor’s office might make you uneasy. You may be wondering, “Does Medicare cover virtual doctor visits?” The good news is that you may be able to communicate with your doctors or other practitioners regarding COVID-19 without going to the office in person. Medicare provides coverage for the following services to help its beneficiaries maintain social distancing:
- Virtual check-ins: Virtual check-ins are brief, virtual interactions with your physician or certain other providers. To qualify, this communication can’t be related to a medical visit that happened within the previous 7 days and it can’t lead to a medical visit within the next 24 hours (or soonest appointment available). Virtual check-ins use audio and video communication technology such as phone, text messages, email, or web (e.g. patient portal). They can be done from anywhere, including your home, a nursing home, or an assisted living facility.
- Telehealth: Telehealth services include a range of virtual health or medical services delivered by a provider who is at a different location. These services include common office visits, consultations, and mental health counseling. Does Medicare cover telehealth services? Under Medicare Part B, certain telehealth appointments are covered, including those related to COVID-19. If, during your virtual visit, the doctor determines you’re at risk for COVID-19, they’ll arrange for you to receive a test at the nearest operating testing facility.
You will still be responsible for any coinsurance and deductibles related to your telehealth visit. For most telehealth services, the out-of-pocket costs reflect what you'd pay for an in-person appointment. Talk to your provider for a better idea of how much your service will cost.
- E-visit: An e-visit allows you to talk to your doctor or certain other practitioners via a secure online patient portal regarding minor, non-emergent medical matters. Medicare Part B provides coverage for e-visits; the standard coinsurance and deductible apply. Like telehealth services, e-visits can be used for the treatment of COVID-19 from anywhere, including home, nursing homes, and assisted living centers.
What about Medicare coverage for home health care during COVID?
Home health care provides specific medical and health services while you’re recovering at home from illness or hospitalization related to COVID-19 or other conditions. During the pandemic, home health agencies have continued to care for Medicare beneficiaries. This has helped with infection control and lessening the impact on acute and long-term care facilities. In addition to registered nurses and licensed practical nurses, nurse practitioners, physician assistants, and clinical nurse specialists can now provide home health services without needing a physician’s certification.
Under Medicare Part B, you qualify for home health care if you’re homebound and require skilled care—even if you haven’t been previously hospitalized. If you’ve just spent time in the hospital or a skilled nursing facility, you can receive home health care coverage under Medicare Part A. You're not eligible for the Medicare home health benefit if you require more than part-time or sporadic skilled nursing care. Medicare also does not cover 24/7 home care, meals delivered to your home, or homemaker or personal care when it's the only type of care needed.
Stay up to date on Medicare coverage for COVID-19
If you have questions regarding Medicare and COVID-10, contact 1-800-Medicare or visit www.medicare.gov/medicare-coronavirus. You can also contact your local State Health Insurance Assistance Program (SHIP) at www.shiphelp.org or by calling 877-839-2675. SHIPs provide unbiased insurance counseling and assistance to Medicare-eligible individuals as well as their families and caregivers.