Table of Contents:
- COVID-19’s Impact
- Medicare and COVID-19 Testing
- Medicare and COVID-19 Treatment
- Medicare and the COVID-19 Vaccine
- Medicare’s Future and COVID-19
The ongoing COVID-19 crisis has dominated the news cycle throughout 2020 and will again this year. Reaching pandemic status in mid-March, the virus infected more than three million Americans by the year’s midpoint.
Individuals who are elderly or have pre-existing conditions are especially vulnerable to COVID-19 infection, severe symptoms, and serious economic consequences. Analysis from the Kaiser Family Foundation (KFF) suggests that 37.6% of U.S. adults (including nearly every Medicare beneficiary) are at elevated risk due to their age and/or preexisting conditions.
On June 22nd, the Centers for Medicare and Medicaid Services (CMS) published a “snapshot” of COVID-19’s impact on Medicare beneficiaries between the beginning of the year and May 16th. CMS reports that its data confirms speculation that seniors and disabled Americans are especially vulnerable to COVID-19. What’s more, it affirms that low-income and minority populations are especially vulnerable to both the disease and its economic repercussions.
518 Medicare beneficiaries per 100,000 contracted COVID-19 and were hospitalized before mid-May — over 300,000 in total. 110,000 of these enrollees were hospitalized for treatment. Black beneficiaries were four times more likely and Hispanic beneficiaries were two times more likely to be hospitalized than white beneficiaries. Infection rates are also significantly higher among dual-eligible beneficiaries than among Americans who are enrolled in Medicare alone.
Medicare and COVID-19 Testing
To expand access to COVID-19 testing, the White House and Congress updated Medicare’s policies in late April 2020. Original Medicare beneficiaries are no longer required to obtain a referral from their primary care physician to get tested. What’s more, generally, they cannot be charged anything for tests to either diagnose COVID-19 or identify the presence of antibodies if they have or are suspected to have an infection. Medicare Advantage beneficiaries are fully covered too.
Medicare and COVID-19 Treatment
Original Medicare beneficiaries are subject to the usual Part A charges for in-patient COVID-19 care in 2021:
- Beneficiaries pay a deductible of $1484/benefit period for inpatient care.
- After 60 days in the hospital, beneficiaries are charged $371/day until they reach 90 days of treatment.
- After 90 days of treatment within a single benefit period, beneficiaries have access to 60 “lifetime reserve days.” Lifetime reserve coinsurance totals $742/day.
Beneficiaries who are admitted to a hospital for COVID-19 treatment may need to quarantine within the facility for up to two weeks before they are discharged. In these situations, beneficiaries are exempt from any additional daily coinsurance charges.
CMS has given Medicare Advantage providers the option to adjust cost sharing requirements for COVID-19 treatment. A number of providers have outlined their policies for doing so. Many are eliminating cost-sharing requirements altogether until further notice.
Medicare and the COVID-19 Vaccine
Original Medicare only provides free access to certain vaccines. Others are available only after beneficiaries have paid their Part B deductibles and coinsurance. The CARES Act, passed in March, guarantees that any future COVID-19 vaccine will be fully covered by Medicare Part B. This will enable both Original Medicare and Medicare Advantage beneficiaries to access the vaccine without any cost sharing.
Medicare’s Future and COVID-19
KFF and the Center for Budget and Policy Priorities predict that COVID-19 could have a domino effect. By putting incredible financial pressure on beneficiaries and those eligible for Medicare, the pandemic will subsequently put pressure on Medicare itself. In addition to mounting charges, Medicare faces the rapid depletion of its trust fund. This is the result of record unemployment numbers which are driving down payroll taxes and decreasing the program’s income. This situation could leave Medicare beneficiaries suffering short-term consequences in the form of increased out-of-pocket spending and long-term consequences in the form of more cost sharing.
Since its start, the crisis has further intensified conversations around healthcare reform. Specifically, it has inspired a number of progressive politicians and activists to amplify their calls for a single-payer healthcare system (“Medicare for All”). At least one big change to Medicare could be coming this year. President Joe Biden has pledged to reduce the program’s eligibility age to 60.
Information adapted from the Centers for Medicare & Medicaid Services
Additional data and cost information adapted from the U.S Department of the Treasury, America’s Health Insurance Plans, and Kaiser Family Foundation
The CARES Act Works for All Americans, 2020. U.S. Department of the Treasury.
Health Insurance Providers Respond to Coronavirus (COVID-19), 2020. America’s Health Insurance Plans.
FAQs on Medicare Coverage and Costs Related to COVID-19 Testing and Treatment, 2020. Kaiser Family Foundation.