Does Medicare Cover COVID-19 Testing and Vaccination?

Does Medicare Cover COVID-19 Testing and Vaccination?
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Does Medicare Cover COVID-19 Testing and Vaccination?

Does Medicare Cover COVID-19 Testing and Vaccination?
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There are currently over 61 million Medicare beneficiaries in the United States. This federal health insurance program covers people 65 years of age and older, some younger people with disabilities, and anyone who is suffering from End-Stage Renal Disease who requires regular dialysis on an ongoing basis. If you or a loved one receives care under this federal health insurance program, you may be wondering what Medicare will cover in terms of COVID-19 testing and vaccination.

Since the beginning of the COVID-19 pandemic, federal policymakers have responded to the need for increased access to testing, treatment, and vaccination. They have enacted a series of laws and regulations intended to ensure public safety and to curb the spread of the disease. These changes have dictated how federal, state, and private healthcare providers should respond to anyone who seeks testing for COVID or a COVID-19 vaccine.

Types of COVID-19 Tests

There are a variety of COVID-19 tests, but the major distinction is in how these tests are used. Some tests are administered to detect a current or ongoing infection, while others are used to determine if someone has previously been infected with COVID-19. Though both kinds of tests are useful for different purposes, only one type of test will be administered depending on your specific situation. Your doctor or healthcare provider will determine which type of test you need.

Viral Tests

Viral tests, which are also called diagnostic tests, are used to detect whether someone is currently infected with the COVID-19 virus, and therefore needs to quarantine or isolate themselves from others. There are two different kinds of diagnostic tests currently in use—antigen and PCR tests. Samples for both types of diagnostic tests are usually collected with a nasal or throat swab, or by the collection of saliva in a small plastic tube. In some cases, these samples can be collected in your home by a home health nurse, a trained medical assistant, or a laboratory technician.

Antigen Testing

Antigen tests, which are also called rapid tests, are used to determine whether someone is currently infected with COVID-19. This test works by detecting protein fragments that are specific to the virus and can be carried out in a clinic, hospital, doctor’s office, or in some pharmacies. The results from these tests are usually quick, and in many cases can be reported in as little as 15 minutes.

PCR Testing

PCR testing is generally considered to be the most effective way to detect the virus which causes SARS-CoV-2, but these tests take longer to determine a positive or negative result. PCR tests work by detecting genetic material called RNA that identifies the COVID-19 virus and can detect the virus within only a few days of infection, even in people who show no symptoms. This test can also be carried out in a clinic, hospital, or sometimes in special parking lot clinics where you can be tested without leaving your car.

Though the results can be determined in as little as 24 hours, they generally take two to three days. If the demand for this kind of test is high, results may even take a week or longer.

Antibody Tests

Antibody tests, which are also called serology tests, are used to determine if someone has been previously infected with COVID-19. These kinds of tests look for antibodies in the blood that were produced by the immune system in response to SARS-CoV-2, the virus that causes COVID-19. Antibodies can take anywhere from several days to weeks to develop after infection and will stay in the blood after recovery, though the length of time these antibodies stay present is not currently known. Samples for these kinds of tests are typically collected as blood from a finger stick or in blood which is drawn by your doctor or other health professional.

Who Should Get Tested?

The Center for Disease Control recommends that anyone with signs or symptoms of COVID-19 be tested as soon as possible, even if they have been vaccinated or had prior infection. Typical symptoms are:

  • Fever or chills

  • Cough

  • Sore throat

  • Headache

  • Shortness of breath

  • Fatigue

  • Muscle or body aches

  • New loss of smell or taste

  • Congestion or runny nose

  • Nausea or vomiting

  • Diarrhea

The CDC also recommends that you get tested if you have had close contact (such as being within six feet for a total of 15 minutes or more) with someone who has a confirmed COVID-19 infection. Even those who are fully vaccinated should be tested three to five days after any known exposure to someone with suspected or confirmed COVID-19 and should wear a mask in public and indoor settings for two weeks or until they receive a negative test result.

You should also be tested if you are unvaccinated and have taken part in activities such as travel, attending large gatherings, or spending time in crowded or poorly ventilated indoor settings. These activities are known to put people at higher risk for COVID-19 infection due to the inability to physically distance to avoid exposure.

Does Medicare Cover COVID-19 Tests?

Yes. Both Medicare Advantage plans and Medicare Part B will cover all costs associated with COVID-19 testing. These tests do not need prior authorization from a doctor and can be conducted by any laboratory, pharmacy, doctor, or hospital. In some cases, a healthcare practitioner may come to your home to administer a test, and this is also covered.

This coverage includes tests that are used to diagnose COVID-19, as well as some tests for respiratory conditions that may occur with COVID-19. Medicare Part B will also cover any antibody tests if you have been diagnosed with COVID-19 or if your health care provider suspects you may have had it in the past. Both diagnostic and antibody test coverage extends to all copays, deductibles, and coinsurance.

Getting Vaccinated: What to Know

The federal government is currently buying and distributing all COVID-19 vaccines in an effort to curb the spread of this disease. In exchange for receiving these free vaccines, pharmacies, hospitals, and other vaccination providers have agreed to vaccinate individuals free of charge regardless of insurance or medicare coverage. It is unclear if this is subject to change, but at present, there are no plans to end the various programs and initiatives that make universally free vaccination access possible.

Will Medicare Cover COVID-19 Vaccination in the Future?

If the current federal programs should end, Medicare will cover all costs associated with vaccination against COVID-19. It will not matter which COVID-19 vaccine you're getting (such as Johnson & Johnson, Pfizer, etc.), and this coverage will apply to both first and second shots, as well as any booster shots which may be required. This coverage also extends to any deductible, copay, or administration fee.

Have your Medicare card or Medicare number with you so your healthcare professional or pharmacy can bill Medicare as needed. You may be asked to fill out a form prior to receiving your vaccination. If this happens, leave any “group number” field blank or write “N/A” in the space provided.

How to Get Vaccinated at Home

If you have federal Medicare insurance and have a disability or are otherwise unable to get to a location away from your home to receive vaccination, Medicare will pay for a doctor or other healthcare professional to administer one of the COVID-19 vaccinations to you in your home. Ask your regular doctor or other healthcare provider if they can send someone to your home to vaccinate you.

If they’re unable, ask if they can refer you to someone who can, or contact your state or local health department. The CDC also maintains a webpage where you can find more information about getting a COVID-19 vaccine at home, along with a list of resources that may be helpful.

For more information about receiving a COVID-19 vaccination in your area, contact your state or local health department, or visit their websites. You can also go to Vaccines.gov, a website maintained by the CDC, to find a COVID-19 vaccine near you. For other questions about benefits, information on how to get the most out of your Medicare coverage, or to request a quote, check out these popular providers.

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