Medicare Part B fully covers diagnostic tests for COVID-19. In some circumstances, a home health nurse, laboratory technician, or an appropriately trained medical assistant may collect the beneficiary’s test sample in their home for this test.
Key Takeaways
- Testing for COVID-19 is conducted by taking a nasal or saliva sample and testing for the virus’s genetic or protein materials.
- COVID-19 antibody testing is fully covered by Medicare Part B at any Medicare-approved facility.
- Medicare Advantage provides coverage for COVID-19 testing but may require testing within the plan’s network of providers.
What Is COVID-19?
Coronaviruses are a class of viruses that cause illnesses like the common cold, severe acute respiratory syndrome (SARS), or Middle East respiratory syndrome (MERS). This new virus is known as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease is now commonly known as COVID-19 (Coronavirus Disease 2019). Symptoms for COVID-19 can include:1Mayoclinic.org, “Coronavirus disease 2019 (COVID-19)“, Accessed October 29, 2021
- Fever
- Cough
- Tiredness
- Loss of taste or smell
- Shortness of breath or difficulty breathing
- Muscle aches
- Chills
- Sore throat
- Runny nose
- Headache
- Chest pain
- Pink eye (conjunctivitis)
- Nausea
- Vomiting
- Diarrhea
- Rash
In response to the rapid spread of COVID-19, the World Health Organization (WHO) declared the COVID-19 outbreak to be a pandemic in March 2020. The U.S. Centers for Disease Control and Prevention (CDC) and WHO closely monitor the pandemic and regularly post updates on their websites. These public health groups also offer recommendations on how to prevent and treat the disease.1Mayoclinic.org, “Coronavirus disease 2019 (COVID-19)“, Accessed October 29, 2021
How Is the COVID Test Administered?
There are two types of tests for diagnosing COVID-19 that have been approved by the U.S. Food and Drug Administration (FDA):2Mayoclinic.org, “COVID-19 diagnostic testing“, Accessed October 29, 2021
- PCR (polymerase chain reaction) tests, which are a laboratory technique used to detect the genetic material of COVID-19. A swab is inserted in the back of the nostril or throat to collect a fluid sample for PCR testing. Sample testing can be conducted rapidly on-site for faster results, but having it sent to a proper lab for analysis for a couple of days is less likely to produce a false-negative test result.
- Antigen tests, which are used to detect specific proteins found in the coronavirus. Antigen tests require a nasal fluid sample via swabbing and results can be acquired rapidly. There is a chance of receiving a false-negative test result with this method, so a beneficiary’s doctor may ask them to receive a PCR test as well to confirm the result.
How Does Medicare Cover COVID Testing?
COVID-19 testing is covered in full under Medicare Part B. The test costs nothing when administered in any Medicare-covered facility, such as a laboratory, pharmacy, hospital, or a Medicare-approved parking lot test site. Medicare may cover a home health nurse, laboratory technician, or an appropriately-trained medical assistant to collect a testing sample from a beneficiary in their home if the beneficiary cannot leave their home.3Medicare.gov, “Coronavirus disease 2019 (COVID-19) tests“, Accessed October 29, 2021
How Much Does COVID Testing Cost?
You pay nothing for a COVID test in a Medicare-approved facility. Medicare Part B normally covers 80 percent of costs for approved services. However, this is not the case with COVID testing services. You do not have to worry about any deductibles, copayments, or coinsurances.3Medicare.gov, “Coronavirus disease 2019 (COVID-19) tests“, Accessed October 29, 2021
Medicare Advantage
Medicare Advantage plans are required to cover the same services as Medicare Part A and Part B, in addition to any expanded services offered. That includes COVID-19 tests. However, Medicare Advantage plan rules may require their members to use network providers for all tests, including the COVID-19 antibody test.4Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed October 29, 2021
Summary
Original Medicare and Medicare Advantage plans cover COVID-19 antibody tests in full. You pay nothing out-of-pocket for this service. If you are experiencing COVID-19 symptoms and/or have been in contact with someone that tested positive for COVID-19, go get tested for COVID-19 as soon as possible. Many parking lot COVID-19 test sites do not need an appointment, so you can just walk up and request a test.
Citations
- 1Mayoclinic.org, “Coronavirus disease 2019 (COVID-19)“, Accessed October 29, 2021
- 2Mayoclinic.org, “COVID-19 diagnostic testing“, Accessed October 29, 2021
- 3Medicare.gov, “Coronavirus disease 2019 (COVID-19) tests“, Accessed October 29, 2021
- 4Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed October 29, 2021