While a number of COVID-19-related services are offered with no out-of-pocket spending for Medicare and Medicare Advantage participants, a new study predicts up to 6 million seniors would have to pay out of pocket on their own for health care services if they catch the virus.
This is because that many seniors didn’t purchase Medicare Advantage or another Medicare Supplement policy, and because Original Medicare does not cap out-of-pocket expenses for medical treatment, according to a brief published by the Patient Assistance Network Foundation.
The paper illustrates why it’s so important to spend a little more every month for peace of mind in case you need treatment for a serious ailment. Without the backstop of Medicare Advantage or other Medicare Supplement policies, you risk financial calamity.
With the specter of COVID-19 hanging around for at least a few years, and the elderly more at risk of having serious complications from the disease, having just an Original Medicare policy is a huge gamble.
The brief points out that many COVID-19-related services are fortunately covered by both Medicare and Medicare Advantage plans with no out-of-pocket requirements for the enrollee. This includes, in particular:
- COVID-19 testing and testing-related services
- In-person office visits and telehealth visits
- Emergency room visits
- Inpatient hospitalization
- COVID-19 vaccine (that is, once a vaccine becomes available. Currently there is no vaccine, but a number have already entered clinical trials).
Although both Original Medicare and Medicare Advantage cover the services that patients need if they are infected with COVID-19, in many cases, patients are still responsible for out-of-pocket costs for these services. However, these out-of-pocket expenses differ depending on the service a patient receives as well as their type of Medicare coverage.
The following services are covered to varying degrees with cost-sharing:
In-person doctor’s office visits
- Original Medicare: The Part B deductible of $198 in 2020 applies and, after the deductible is met, 20% coinsurance applies.
- Medicare Advantage: Cost-sharing varies by plan.
Telehealth visits
- Original Medicare: The Part B deductible of $198 in 2020 applies and, after the deductible is met, 20% coinsurance applies.
- Medicare Advantage: Cost-sharing varies by plan.
Emergency room visits
- Original Medicare: The Part B deductible of $198 in 2020 applies and, after the deductible is met, 20% coinsurance applies as well as copayment for both emergency room visits and hospital services.
- Medicare Advantage: Cost-sharing varies by plan.
Inpatient hospitalization
- Original Medicare: The Medicare Part A deductible of $1,409 per hospital visit in 2020 applies. No coinsurance for days 1-60; coinsurance of $352/day for days 61-90.
- Medicare Advantage: Cost-sharing varies by plan.
The danger with the above costs for enrollees that only have Original Medicare is that out-of-pocket costs are not capped, unlike in Medicare Advantage and other supplement plans. This is why the study concludes that 6 million American seniors could be left holding the bag for their COVID-19-related treatment costs. Contact us to discuss your options for a Medicare Supplement or Medicare Advantage Plan.