COVID Recovery Benefits Under Medicare Coverage

Unfortunately, the Pandemic isn’t Over Yet.

Even though the world has reopened, masks have become largely optional, and the life-altering changes of 2020 are becoming a thing of the past, COVID-19 hasn’t gone away completely. Many researchers believe that COVID-19 is on track to becoming an endemic virus: a seasonal disease similar to influenza or the common cold. 

While this can be considered a good sign, as it means the overall lethality of the virus is decreasing, it doesn’t mean we’re out of the proverbial woods. COVID-19 remains a dangerous virus, particularly for those with underlying conditions and compromised immune systems. As such, it is important to be aware of what Medicare will cover in terms of preventing, treating, and recovering from COVID-19.

Before we begin, we should note that COVID-19 is still considered a public health emergency. As such, the specific benefits listed here may change as the virus becomes endemic. 

Does Medicare Cover COVID Prevention?

If you have not yet been vaccinated for COVID-19, you should do so as soon as possible. The COVID-19 vaccine, including any recommended boosters, is available at no cost to you regardless of your current insurance status. This may change in the future, but as similar preventive vaccines like the flu shot are already covered under Medicare Part B at no cost to beneficiaries, anyone enrolled in a Medicare plan should be able to reliably receive a COVID-19 vaccine, barring any supply issues.

COVID-19 tests are also covered under Medicare. While any American can currently request COVID-19 antigen tests through the mail at no cost, Medicare beneficiaries may show their Medicare card at participating pharmacies to receive up to eight tests per month. In addition, lab tests for COVID-19 are covered at no additional cost and may be administered at a testing center or as recommended by a doctor. Medicare COVID testing coverage is likely to change as the virus transitions from pandemic to endemic status, however. As such, lab tests will likely fall under the purview of Medicare Part B once the transition hits. 

For those concerned about infection, Medicare has expanded telehealth coverage to further reduce exposure.

Medicare COVID Coverage

If you do test positive, what happens next depends on your personalized health plan.

Antiviral drugs, such as Paxlovid, may be prescribed to those with weakened immune systems if the infection is caught early enough. These drugs can reduce the severity and duration of COVID-19 infection when taken as directed, preventing hospitalization. Paxlovid and similar drugs are available by prescription only but are covered at no cost by the government as part of the current public health emergency. This may change in the future, but currently, no special healthcare plan is needed to receive antiviral treatment.

For patients unable to take antivirals due to allergies or drug interactions, Medicare will cover monoclonal antibody treatments for COVID-19. This is an infusion of antibodies designed to help your immune system fight off the virus, though it is not as effective as antiviral medications. 

Both treatments require rapid administration, typically within five to ten days of the onset of symptoms. They are also not intended as substitutes for the COVID-19 vaccine, which remains the most effective way to prevent infection.

In the event of hospitalization related to COVID-19, Medicare Part A will cover in-patient treatment as normal, with the typical copayments, co-insurance, and deductibles associated with Part A coverage. The only difference from typical Part A coverage is the use of a private room to prevent the spread of the virus. If you wish for more luxurious hospital amenities, you will either need to provide them yourself or choose a Medicare Advantage plan that covers them.

COVID Recovery and Medicare

Regardless of whether or not you require hospitalization, Medicare will cover services designed to aid in COVID-19 recovery. 

One major benefit is home health care, which we cover in detail here. Home health care can reduce the risk of spreading infection and can cover a variety of recovery services, such as physical and occupational therapy. Depending on the severity of your symptoms, Original Medicare may also cover pulmonary rehabilitation to help restore your lung functionality. 

If you have a qualifying Medicare Advantage plan, you may also qualify for quality of life benefits, such as meal delivery and OTC medication coverage, which can help with the recovery process. Check with your provider to see what specific COVID-19 benefits they offer.

Long COVID, or Post-Covid Conditions (PCC)

A minority of COVID sufferers may develop long-term symptoms, colloquially known as “Long COVID”, and officially known as Post-Covid Conditions (PCC). The causes of PCC are still poorly understood, and there is currently no 100 percent effective treatment supported by currently available data. 

In fact, while the scientific community recognizes that PCC exists, many sufferers have found difficulty getting diagnosed, as the symptoms are both non-specific and inconsistent. It is possible that PCC is the result of a variety of factors that vary from patient to patient, but studies are still ongoing. Roughly one-in-five Americans will develop PCC after COVID-19 infection, even if their initial symptoms were too mild to warrant hospitalization.

Because PCC symptoms vary, Medicare does not have a specific plan for handling it. Instead, the usual division of services is used. Outpatient therapeutic interventions are handled under Medicare Part B, prescription drugs are covered under Medicare Part D, and any inpatient services are covered under Part A. Hospitalization for PCC is unlikely, but may result from complications like organ damage, heart palpitations, or shortness of breath. 

If your PCC symptoms are severe enough, you may qualify for disability insurance. This is likely to occur if your PCC symptoms interfere with your ability to perform major life activities. After receiving disability for 24 months, you become eligible for Medicare benefits regardless of your current age.

Individuals with PCC may benefit from Medicare Advantage coverage; specifically, Special Needs Plans (SNPs), which provide tailored benefits designed to treat chronic conditions. Though a comprehensive SNP for PCC does not currently exist due to the condition’s novel nature and inconsistent presentation, specific manifestations of PCC may qualify you for an SNP, including:

An SNP will cover any treatment specific to your condition and is required by law to cover prescription medications. Talk with your doctor about any PCC symptoms you may be experiencing to receive an official diagnosis, then contact a licensed insurance agent to find an SNP that fits your needs.