The Public Health Emergency for COVID-19 ended May 11, 2023. This means:
- Medicare will continue to cover COVID-19 vaccines under Medicare Part B at no cost to you.
- You might have out-of-pocket costs for COVID-19 diagnostic tests.
- Medicare will not cover over-the-counter tests.
- Telehealth services will continue through Dec. 31, 2024.
To stay informed about Medicare coverage and COVID-19, along with tips to keep yourself safe, visit medicare.gov.
COVID-19 testing
Original Medicare no longer covers over-the-counter at-home tests. Original Medicare does cover two other kinds of COVID-19 tests when the test is ordered by a physician or other health care practitioner. These two types of covered tests are PCR tests (which identify genetic material) and antigen tests (which are often called rapid tests). There is no out-of-pocket cost to you.
Medicare Advantage plans must cover COVID-19 tests. However, you may have out-of-pocket costs. Contact your plan to learn more about costs. Medicare Advantage plans may also continue to cover over-the-counter at-home tests at no cost. Contact your plan to learn if this supplemental benefit is offered, and how to access it.
COVID-19 vaccine
Original Medicare Part B covers COVID-19 vaccines and boosters, regardless of whether you have Original Medicare or a Medicare Advantage Plan. You pay nothing for the vaccine or boosters.
Bring your red, white, and blue Medicare card with you to your vaccination appointment, even if you have a Medicare Advantage Plan. If you do not have your card on you, your vaccine provider may ask you for your Social Security number so that they can look up your Medicare information.
COVID-19 treatments
Monoclonal antibodies
Medicare covers certain monoclonal antibodies to treat COVID-19 for some people. You owe no cost-sharing (deducible, coinsurance, or copay) for covered treatments.
Inpatient and outpatient treatment
Medicare Part A covers medications you receive as a hospital inpatient. Medicare Part B covers medications you get from a health care provider as an injection or infusion. An example of an injected medication is Remdesivir. You may owe cost-sharing (deductible, coinsurance, or copay) for these treatments. Medicare Advantage plans also cover these treatments. Contact your plan to learn more about costs.
Prescription drugs
Paxlovid is a medication used to treat COVID-19 that is available at the pharmacy. The government has paid for a certain amount of Paxlovid. While the supply of Paxlovid from the government lasts, you pay no cost-sharing. After the supply has been used, Part D covers Paxlovid. Paxlovid may be on your plan’s list of covered drugs, or you may have to ask your plan to make an exception and cover the drug. You may owe cost-sharing (deductible, coinsurance, or copay)
Medicare telehealth coverage
Through Dec. 31, 2024, Medicare beneficiaries can receive a wide range of health care services through telehealth from their doctors without having to travel to a health care facility. This means Medicare will pay for services when furnished via telehealth, such as:
- Common office visits
- Mental health counseling
- Preventive health screenings
Beneficiaries may use phones or smart phones and other devices that have audio and video, or just audio capabilities to get telehealth services.
Telehealth services are billed at the same amount as in-person services. Medicare coinsurance and deductibles still apply.
Be aware of COVID-19 vaccine scams
COVID-19 scammers are still out there. They target older adults and those with serious long-term health conditions who appear to have a higher risk for serious illness from COVID-19. They attempt to bill Medicare for sham tests or treatments related to COVID-19 and target people to illegally get money and/or Medicare numbers.
Here are some tips to avoid becoming a fraud victim:
- Do not give out your Medicare number to anyone other than your doctor, health care provider or other trusted representative.
- Protect your Medicare number and treat your Medicare card like a credit card.
- Never provide your Medicare number to anyone who contacts you through unsolicited calls, texts or emails.
- Don’t post on social media that you are getting tested for COVID-19. Scammers can use this to provide false reports and request your Medicare information.
- Be cautious when buying medical supplies from unverified sources, including online advertisements and email/phone solicitations.
How SHIBA, your local Senior Medicare Patrol, can help
To report COVID-19 Medicare vaccine fraud, contact your local SHIBA (Statewide Health Insurance Benefits Advisors) program, your Washington state Senior Medicare Patrol, at 800-562-6900. We can help clients prevent, detect and report Medicare and Medicaid fraud and abuse.
Part of the Washington state Office of the Insurance Commissioner, our trained SHIBA/SMP volunteers help educate and empower Medicare beneficiaries in the fight against health care fraud. We can help you with your questions, concerns or complaints about potential fraud and abuse issues. We also can provide information and educational presentations.