The COVID-19 public health emergency (PHE) ended on May 11, 2023. During the PHE, there were some changes to Medicare coverage that will no longer be in place.
COVID-19 testing
Original Medicare Original Medicare, also known as Traditional Medicare, is the fee-for-service health insurance program offered through the federal government, which pays providers directly for the services you receive. Almost all doctors and hospitals in the U.S. accept Original Medicare. covers COVID-19 testing with no cost-sharing (no deductible The deductible is the amount you must pay for health care expenses before your health insurance begins to pay. Deductible amounts can change every year. , coinsurance The coinsurance is the portion of the cost of care you are required to pay after your health insurance pays. Usually, it is a percentage of the approved amount or negotiated amount. In Original Medicare, the coinsurance is usually 20% of Medicare’s assignment. , or copayment A copayment, also known as a copay, is a set amount you are required to pay for each medical service you receive (like $35 for a doctor’s visit). ) when the test is ordered by a physician or other health care practitioner. The two kinds of covered tests are:
- PCR tests, which identify genetic material
- Antigen tests, which are often called rapid tests
Original Medicare does not cover over-the-counter at-home tests as of May 11, 2023.
Medicare Advantage Medicare Advantage, also known as Part C, Medicare Private Health Plan, or Medicare Managed Care Plan, allows you to get Medicare coverage from a private health plan that contracts with the federal government. All Medicare Advantage Plans must offer at least the same benefits as Original Medicare (Part A and Part B), but can do so with different rules, costs, and coverage restrictions. Plans typically offer Part D drug coverage as part of Medicare Advantage benefits. Medicare Advantage Plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) plans, Special Needs Plans (SNPs), and Medicare Medical Savings Accounts (MSAs). Plans must cover COVID-19 tests. However, there may be out-of-pocket costs Out-of-pocket costs are health care costs that you must pay because Medicare or other health insurance does not cover them. as of May 11, 2023. 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 Part B, also known as medical insurance, is the part of Medicare that covers most medically necessary doctors’ services, preventive care, hospital outpatient care, durable medical equipment (DME), laboratory tests, x-rays, mental health services, and some home health care and ambulance services. 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 booster.
Skilled Nursing Facility (SNF) care
Part A Part A, also known as hospital insurance, is the part of Medicare that covers most medically necessary hospital inpatient care, skilled nursing facility (SNF) care, home health care, and hospice care. typically only covers skilled nursing facility care if you were formally admitted as an inpatient An inpatient is a patient who has been formally admitted into the hospital by a doctor. Most inpatient care is covered under Medicare Part A (hospital insurance). to a hospital for at least three consecutive days. During the PHE, Medicare removed the three-day hospital stay requirement if you were affected by the COVID-19 public health emergency. This change is no longer in place as of May 11, 2023.
Medicare also changed other SNF requirements. Typically, Part A covers up to 100 days of SNF care each benefit period. A benefit period begins when you are admitted to the hospital as an inpatient, or to a SNF, and it ends when you have been out of the SNF for at least 60 days in a row. After your benefit period has ended, you receive another 100 days of SNF care at the start of a new benefit period. During the PHE, if you were unable to end a benefit period and start a new one because of the public health emergency, you could get another 100 days of covered SNF care without having to begin a new benefit period. This change is no longer in place as of May 11, 2023.
Telehealth services
Through September 30, 2025, Medicare covers telehealth visits whether you:
- Live in a rural or urban area
- Get the services at home or in health care settings
Medicare covers hospital and doctors’ office visits, mental health counseling, and other visits via telehealth. If you have a Medicare Advantage Plan, it must cover telehealth services as well. Contact your plan to learn about costs and coverage.
After September 30, 2025, coverage for telehealth benefits may be more limited.