The daily lives and routines of many family caregivers are already challenging, but the stress and anxiety of the pandemic can bring exhaustion to new levels. Medicare is complex in and of itself, so it may be helpful to someone to provide guidance about COVID-19 coverage. This edition of the Caregiver Coalition blog provides information about ways Medicare has relaxed some of its rules due to the Coronavirus pandemic, giving families some much-needed relief on healthcare issues.
Coverage for Testing, Vaccines:
Medicare covers the lab tests for COVID-19 to see if you currently have the disease (regardless of existing symptoms) and you pay no out-of-pocket costs. Medicare also covers tests for antibodies to determine if you have had COVID-19. Click here for Medicare coverage of COVID-19 antibody tests.
Medicare also covers (and you pay nothing) for some tests for related respiratory conditions to aid diagnosis of COVID-19 done together with the COVID-19 test.
If you have a Medicare Advantage Plan (Part C), Medicare allows these plans to waive cost-sharing for COVID-19 lab tests as well. Such Plan cannot charge co-payments, deductibles, or coinsurance for clinical lab tests to detect/diagnose COVID-19.
Be sure to get your test from a laboratory, pharmacy, doctor, hospital or “parking lot” test site for which Medicare covers the cost.
If/when a vaccine becomes available for COVID-19, it will be covered by Part D. For details, click here Medicare Prescription Drug Plans (Part D).
Many plans offer additional telehealth benefits. Check with your plan about your coverage and costs.
Medicare covers all medically necessary hospitalizations, including 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 must still pay for any hospital deductibles, copays, or coinsurances that apply. Click here to see exactly what you pay.
Coverage: Medicare Part A (Hospital Insurance) covers inpatient hospital care as long as the hospital accepts Medicare, and the patient is admitted to the hospital as an inpatient after an official doctor’s order requiring inpatient hospital care to treat the illness or injury.
Skilled Nursing Facilities (SNF)
What is Skilled Nursing Care? It is health care given when you need skilled nursing or skilled therapy to treat, manage, and observe your condition, and evaluate your care. It can only be safely and effectively performed by, or under the supervision of, professionals or technical personnel.
Coverage: Medicare Part A (Hospital Insurance) covers skilled nursing care only for a limited time. What does the Medicare recipient have to pay if discharged from the hospital to a rehab or skilled nursing facility?
Days 1–20: $0 for each benefit period.
Days 21–100: $176 coinsurance per day of each benefit period.
Days 101 and beyond: ALL costs.
Money-Saving Tip: Because Medicare does not cover long term care, you must pay using your life-savings, long term care insurance, or qualify for Medicaid. Regarding your life-savings, consult a lawyer who is knowledgeable about this, including long-term care planning, asset protection, and estate planning. Taking these steps now can save you many thousands of dollars down the road and extend your independence, with quality health care, in a setting you prefer.
To receive coverage for skilled nursing home care during “normal” times, Medicare requires a person to first be “admitted” to a hospital as “inpatient” for three consecutive days, known as the two-midnights rule. Note that time spent in the hospital for “observation” does not count, even if the patient stayed for a week and had surgery at the hospital.
Changes due to COVID-19:
Medicare is now waiving certain requirements for care in a skilled nursing facility (SNF). For example, Medicare has temporarily waived the requirement of first having a “qualified hospital stay” (i.e., staying for two midnights). The waiver, however, only applies if you are unable to be in your home or are otherwise affected by the pandemic.
Talk to your loved ones now. Because the waiver is only temporary and has uncertain conditions attached, it is recommended you inform your Health Care Surrogate and Power of Attorney agent NOW that if you are on Medicare and ever headed for the hospital due to COVID-19 or another serious illness, they should insist on having medical records confirm you’re being “admitted” as “inpatient” (i.e., not observation status), which can save you thousands of dollars if discharged to a Rehab or SNF.
Before the doctor orders a discharge from the hospital to a rehab or skilled nursing facility, be sure your stay in the hospital meets the two-midnight rule, so Medicare will help cover the overwhelming expenses.
You can see how complicated Medicare can be. Where do you turn for help? ElderSource has a program called SHINE – Serving Health Insurance Needs of Elders --- that offers Medicare beneficiaries free and unbiased counseling on anything and everything Medicare. SHINE counselors are familiar with the most up-to-date information on Medicare benefits. And, with Medicare Open Enrollment just around the corner (October 15 – December 7) now would be a great time to ensure you have the most current information possible.
Families should also consider enlisting the expertise of an elder law attorney to complete important legal documents (i.e. Power of Attorney, Advanced Directors, Healthcare Surrogate) to ensure that the best healthcare decisions can be made for the loved one.
For more general information, click on these links:
For a SHINE consult call 1-888-242-4464.
Thank you to our contributors:
• Caregiver Coalition member Caroline Emery, Attorney at Law
• Serving Health Insurance Needs of Elders (SHINE), an ElderSource program.