Question: How does Medicare cover my recovery of COVID-19 if I get sick?
Last month I addressed how Centers for Medicare & Medicaid Services (CMS) covered hospital stays and testing of COVID-19 related services. Your question also has been answered by CMS.
Original Medicare gives you excellent Health Insurance all the time. When thinking about COVID-19, this coverage continues to be excellent and useful.
As I said previously, Centers for Medicare & Medicaid Services (CMS) has worked hard to get in front of this situation. CMS has waived all deductibles and cost sharing under Original Medicare and Medicare Advantage Plans for any laboratory tests and related provider visits as they relate to COVID-19 testing, diagnosis and treatment.
When diagnosed with COVID-19 and admitted to the hospital with Original Medicare coverage, there are no deductibles as previously stated. Once released from the hospital, many individuals may need rehabilitation. If you and our doctor decide that a rehab stay in a Skilled Nursing Facility (SNF) is appropriate, Medicare has waived the requirement for a three night hospital stay. This is significant because sometimes individuals don’t need to be in the hospital with COVID-19, but need more care than they themselves or their families can provide. This allows a rehab stay to be covered by Original Medicare and Medicare Advantage Plans without the normally required three night stay in the hospital.
So in reviewing care options it is important for you and your family to seriously consider the option of a rehab stay at a SNF. This facility will have the medical staff you may require to help you recover from this illness. Most of us live in households without medically trained family or caregivers.
You also have up to thirty days from your hospital discharge to determine that you need more care and could re-evaluate the options of a rehab stay at a SNF. This could be a situation where you return home and then maybe find you get sicker, or your care is more than you and your family can provide. This allows you to contact the physician or the hospital you were discharged from. The hospital and physicians can work to make arrangements for you to move to a SNF for a rehab stay.
Original Medicare covers these rehab stays and pays the bill in full for the first twenty (20) days. On day 21 to day 100, there is a cost share left of $174 per day of care in the SNF. Many individuals with Original Medicare also have a Medicare Supplement Plan that would cover this daily $174 cost share in full or in part.
Medicare Advantage Plans have similar rehab stay coverage. The difference is in how it is covered. Many plans cover the first twenty days in full and then a co-pay structure for the next up to 80 days. There are plans that have you pay part of the cost right from the beginning, or have different co-pays for different number of days than dictated in Original Medicare.
This means that Original Medicare and the Medicare Advantage Plans give you a significant amount of time to recover from COVID-19 with the care you need to get you back on your feet.
The likelihood of your contracting COVID-19 and getting very sick is low. Most individuals at this time who test positive for the disease or have had the disease don’t even know they were sick. It is a very low percentage of people who show symptoms and an even smaller percentage who get very sick and require hospitalization. The fear of this disease is real. The contact precautions we have all been encouraged to take, reduce the likelihood you will get sick. It also slows the spread of the disease, so that our healthcare system and those that work in it do not get overwhelmed.
Stay safe and follow the guidelines provided by professionals in the field, like Centers for Disease Control (CDC) and CMS.
Senior Life Matters is a community based program sponsored by Lutheran Jamestown. For questions and concerns or to reach Janell Sluga, GCMC, call us at 716-720-9797 or e-mail at SLM@lutheran-jamestown.org.