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Does Medicare Cover COVID-19 Tests?

Does Medicare Cover COVID-19 Tests

Just the Essentials

  • Although the height of the COVID-19 pandemic is behind us, it is still important to do everything you can to remain safe and healthy.

  • There are three types of COVID-19 tests, all of which are covered by Medicare under various circumstances.

  • Medicare Advantage plans may offer additional benefits to those affected by COVID-19.

  • You can explore your Medicare Advantage options by contacting MedicareInsurance.com today

COVID-19 Isn’t Going Anywhere Anytime Soon

Although the height of the pandemic is behind us, COVID-19 remains a threat, especially for the elderly and immunocompromised. That’s why countermeasures like vaccination, masking while traveling, and regular testing are important. Unfortunately, opportunities to get a no-cost COVID-19 test are dwindling. The government suspended its at-home testing program as of September 2, 2022, and there is no indication if, or when, the distribution of at-home covid tests will be resumed. Amid all this uncertainty, you may be wondering “Does Medicare cover COVID-19 tests?” Fortunately, the answer is yes, at least in most cases. Read on to find out more.

How Do COVID-19 Tests Work?

Covid-19 swab

There are three types of coronavirus tests used to detect COVID-19.

  • Lateral Flow Tests (LFT): If you’ve participated in the government’s at-home testing program, you’re familiar with LFTs. After taking a nasal swab and treating it with the included solution, the sample is exposed to an absorbent pad, similar to a pregnancy test. This strip contains COVID-19 antibodies, which will bind to viral proteins present in the sample, producing a colored line. LFTs produce results in thirty minutes or less.

  • Polymerase Chain Reaction Tests (PCR): PCR tests detect the presence of viral genetic material (RNA) in the body. These tests are administered by a professional in a clinical setting, and the sample is sent to a lab for testing. Results may take several days to return.

  • Antibody Tests (Serology): This type of test is much less common than LFTs and PCRs, as it detects the presence of COVID-19 antibodies using blood samples. As such, it isn’t useful for diagnosis, as it takes weeks for antibodies to develop. However, you may be asked to take a serology test as part of an epidemiological study, or if you are planning on donating plasma.

The majority of COVID-19 tests are LFTs, whether they are self-administered or performed by a medical professional. They are inexpensive, mostly accurate when performed correctly, and produce rapid results. PCR tests are primarily used when a person is already showing symptoms of infection, typically after they have presented to a doctor or emergency services. Serology tests are rare, but can still be recommended under specific circumstances. All COVID-19 tests are covered under Medicare, but the specifics vary depending on the type of test you take.

Lateral Flow Tests

Lateral Flow Covid Test

LFTs are used to diagnose COVID-19 before symptoms appear. You may be required to present a negative LFT test before boarding a cruise or traveling to another country. Many manufacturers recommend taking two tests a week, three to four days apart, if you are at risk of exposure.

Under Medicare Part B, beneficiaries are entitled to eight LFT tests per month at no-cost. This means there is no copayment or deductible required. Tests are offered on a per person, rather than per-household basis. To claim these tests, go to a participating pharmacy and present your Medicare card. Major pharmacies like CVS, Rite-Aid, and Walgreens all participate in the program, as do chains like Walmart and Costco. Ask a pharmacist if your local pharmacy is participating in this program.

Be Aware: Pharmacies will usually only take your government-issued Medicare card as payment for these no-cost LFT tests. Cards issued by a Medicare Advantage provider may not be accepted.

Certain Medicare Advantage providers will cover additional tests beyond the initial eight. Check with your insurance provider to see if they offer this benefit.

Laboratory Tests (PCR and Serology)

COVID Lab Test

Laboratory tests are administered in a clinical setting, and are often used as part of a formal diagnosis. Most lab tests are covered under Medicare Part B, though tests performed as part of a hospitalization may be covered under Medicare Part A instead. Regardless of the context, these tests are covered at no cost when recommended by a doctor. 

Under rare circumstances, you may need to get a PCR or Serology test without a doctor’s approval. While this is increasingly uncommon thanks to advances in LFTs, Medicare will cover one COVID-19 test, in addition to one related test, without prior medical approval. 

What If I Test Positive for COVID-19?

Positive COVID-19 Test

If you test positive for COVID-19 using an LFT, and are not showing any symptoms, you should self-isolate immediately. Stay home, and avoid close contact with others for five days. After five days, if you show no additional symptoms and test negative, it is safe to resume normal activity. However, it is recommended that you wear a mask and avoid contact with high risk individuals for at least eleven days after testing positive.

If you begin showing symptoms within ten days of a positive test, you should remain isolated for at least five days following the onset of symptoms. This is in addition to any days you spent isolated prior to the onset of symptoms. After five days, if your symptoms are improving and you have not had a fever for 24 hours (without the use of fever reducing medication), it is safe to end isolation. Loss of smell and taste may persist for months after infection and do not need to delay the end of isolation.

If you have moderate symptoms, such as shortness of breath, you will need to isolate through day 10, regardless of when your symptoms begin to clear. You should also contact emergency services if you or a loved one:

  • Have trouble breathing

  • Feels persistent pain or pressure in the chest

  • Feels confused or disoriented, despite not showing symptoms previously

  • Is unable to wake or stay awake

  • Has pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone

If you are hospitalized or have a weakened immune system, you will also need to self-isolate through day 10, and may require doctor’s permission and a negative test in order to end isolation. 

These protocols also apply to PCR tests, though your doctor will likely provide more detailed instructions in those cases. A positive serology test is not necessarily a cause for concern: it merely indicates past exposure. Depending on the reason for the test, your doctor will recommend a specific course of action.

What Treatment is Available for COVID-19?

Antibodies attacking coronavirus

Medicare covers a variety of COVID-19 treatments depending on the severity of the disease. For most cases, simply isolating at home and taking over the counter cold medication is the only treatment you will need. In certain situations, your doctor might recommend a monoclonal antibody treatment to boost your body’s ability to fight off the disease, or may prescribe an anti-viral medication. 

If you are hospitalized, you will need to pay the typical Medicare Part A deductible and copayments, but will not need to pay for time spent in quarantine. Medicare Advantage and Medigap plans can reduce or eliminate your cost-sharing obligations for hospital stays, depending on the circumstances. 

Medicare Advantage plans can also offer additional benefits to those in self-isolation, such as expanded access to telehealth services and home meal delivery. Consult your insurance provider for more information.

If you are looking for a Medicare Advantage plan, we can help. Call one of our licensed insurance agents at (800) 950-0608 to begin comparing your options.

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