Does Medicare Cover Covid-19 Testing? Here’s What You Need to Know
The coronavirus continues to affect our communities, though vaccines, testing, and treatments have helped reduce its impact. While the public health emergency ended in 2023, it's still important to protect yourself from Covid-19. Protecting yourself is especially during holiday seasons and summer travel periods when people travel more.
Health experts expect Covid-19, the flu, RSV, and norovirus to go around each winter season. Vaccines and testing offer protection against these viruses—but does Medicare cover Covid-19 testing? Let’s take a look at.
What are Covid-19 tests?
Covid-19 tests use samples to determine if someone is currently infected with the SARS-CoV-2 virus, which causes Covid-19. A simple, at-home nasal swab can generally indicate if you have Covid or not.
There are two types of tests:
Antigen Tests (also known as rapid tests) detect specific proteins on the surface of the virus. While they give quick results (within minutes), they are not always 100% accurate. The test may give you a false negative and miss an infection. At-home tests use antigen testing.
Molecular Tests (like PCR tests) detect the virus's genetic material, which makes them more accurate. The downside is that getting results may take several hours or days. How do home tests compare to lab tests?
PCR tests ("PCR" stands for Polymerase Chain Reaction) are generally the most reliable way to check if you have Covid-19. These tests are analyzed in a lab and can detect even small amounts of the virus. Over-the-counter Covid-19 tests (antigen tests) offer a quick and easy way to determine if you have Covid-19 but aren’t always as accurate.
Does Medicare cover home Covid-19 tests?
Original Medicare generally does not cover the cost of at-home Covid-19 tests. Some Medicare Advantage plans and private health plans may cover them. You could also use FSA or Medicare OTC cards to pay for the tests. The price of an over-the-counter kit can vary, but is generally less than $5 each. There are also now over 30 brands of over-the-counter tests to choose from.
Medicare Part B covers Covid-19 diagnostic tests when ordered by a healthcare provider and performed in a lab.
Are free Covid-19 tests available?
Though the public health emergency is considered over, free tests are still available.
The government may offer four free at-home Covid-19 tests through programs like CovidTests.gov. Some states, like Washington, New York, and Ohio, also have programs to provide free tests to residents. These tests usually need to be ordered from the government site.
Free tests were originally available through 2024 but are still promoted as free on the government website. The new administration in Washington may change the testing program, so check the .gov test site or CDC.gov for any new policies.
Do you have to pay Medicare Part D deductibles and copays for testing?
Generally, no. Medicare Part B typically covers Covid-19 diagnostic lab tests (like PCR tests) when a healthcare provider orders them. Usually, you don’t need to pay the Part B deductible or any coinsurance. Part D is not involved in coverage for Covid tests.
Though Medicare covers diagnostic lab tests for Covid and many other diseases and conditions, there are limits to what it will cover.
Medicare doesn’t cover:
Routine or screening lab tests that are not medically necessary
Cosmetic or experimental tests
Tests for Non-Medicare covered conditions, such as some elective procedures
Does Medicare cover Covid-19 vaccines and boosters?
Medicare Part B covers Covid-19 vaccines and boosters.
As with testing, Medicare beneficiaries should stay informed about changing policies coming out of Washington that may require more cost sharing. In the future, Medicare, Medicaid, Medicare Advantage, and insurance companies may no longer pay for the full cost.
You test positive, now what?
If your home test is positive for Covid-19, contact your doctor or schedule a telehealth visit. Your doctor will guide you on next steps and treatment options.
Most mild Covid-19 cases last up to three weeks. If you're over 65 or have health conditions like diabetes, your doctor might prescribe Paxlovid. This medication works best when started within five days of your first symptoms.
Paxlovid is covered by Medicare and is the leading treatment option for Covid-19. Your doctor will determine if Paxlovid is right for you based on your health needs.
How can you stay up to date on Covid-19 testing and treatment?
For the most accurate and up-to-date information:
Contact Medicare directly: Call 1-800-MEDICARE (1-800-633-4227) or visit the official Medicare website (medicare.gov).
Consult your healthcare provider: They can provide personalized guidance on testing and coverage options.
Check with your specific health insurance plan: Coverage may between different health insurance plans.
Have more questions about Medicare coverage of Covid-19 testing or treatments? Speak with one of our independent Medicare Advisors, who are eager to help you understand your coverage and how to get the most out of Medicare. Get in touch by calling us at (855) 900-2427 or picking a time to chat.