February 20th 2024
By Ari Parker
Though Medicare doesn’t cover at-home tests, it comprehensively covers COVID-related services like vaccines, lab tests, and more.
By Ari Parker
By now, we know about the serious complications that can occur from COVID. Medicare has broad coverage of services related to treating and preventing the virus so you can stay protected.
In this article, you’ll see how Medicare covers the COVID vaccine, options you have for free COVID tests, and COVID-related services that Medicare covers.
Medicare Part B covers the COVID-19 vaccine.
Medicare doesn’t cover at-home tests, but you can get them for free at Covid.gov and at local community locations, like libraries.
Medicare covers services related to COVID like lab tests, antibody tests, medically necessary hospital stays, and oral antivirals. Read on for a more detailed list.
Yes, your COVID shot will be completely free under Medicare Part B. This means that you’ll be covered even if you don’t have a prescription drug plan (which is responsible for coverage of some vaccines). Remember to bring your Medicare card to the pharmacy or healthcare facility so they can bill Medicare.
Medicare will even pay your healthcare provider to give you the COVID vaccine at home if you’re not able to leave your home to get the vaccination. If you need the vaccine administered at home, call your doctor and see if they can give you the vaccine at home. If they can’t, do one of the following:
Call 1-800-633-4227 for vaccine contacts in your state (1-877-486-2048 for TTY users)
See if your doctor can refer you to someone who can administer the vaccine at home
In any case, Medicare will pay for the full cost of a COVID vaccine, either Moderna or Pfizer-BioNTech. A few notes to keep in mind:
People who are immunocompromised and more prone to risk of complication can get a 3-dose series of the vaccine
If you’ve had a previous COVID vaccine, you can get doses of the updated formula
If you had COVID recently, you’ll have to wait at least 3 months before you get the updated vaccine based on CDC recommendations
Check the CDC website to find information on when you can receive the updated formula.
Medicare doesn’t give free COVID tests by mail. It also doesn’t cover over-the-counter (OTC) tests. However, there are other ways you can receive free COVID tests:
Visit Covid.gov to get 8 free at-home tests per household (you’ll have to place 2 orders to receive 8 total)
Check your local community for free at-home tests—many libraries offer free kits, especially during peak season in the fall
Find a no-cost COVID-19 testing center near you (if you choose not to get a lab test)
Yes, Medicare will cover Paxlovid, an oral antiviral COVID treatment, through the end of 2024. You can receive coverage for Paxlovid in two different ways:
Your Part D prescription drug plan covers the medication if your policy participates in the Paxlovid patient assistance program. Get in touch with your plan to see if it participates.
If your drug plan doesn’t participate or you don’t have drug coverage, you can enroll in the U.S. Government Patient Assistance Program (USG PAP) to get Paxlovid covered.
Aside from the COVID vaccine, Medicare provides comprehensive coverage for items and services related to the virus as well.
Medicare Part B pays for COVID testing when your healthcare provider recommends it. Testing must be done at a lab to receive Medicare coverage.
An COVID antibody test checks to see if you have COVID antibodies and if you’ve been infected previously. Antibody testing determines what kind of immune response you have to COVID and whether or not you’re at immediate risk of reinfection. Medicare Part B fully covers the cost of the antibody test if your doctor orders it.
A monoclonal antibody treatment can help you stay healthy and keep you out of the hospital if you test positive for COVID and have mild to moderate symptoms. During this treatment, a healthcare provider gives you a monoclonal antibody infusion. You’ll pay nothing for for this service if you:
Test positive for COVID-19 and are showing symptoms
Your symptoms are mild to moderate
You’re at risk of hospitalization or developing complications
Oral antivirals are medications that stop the COVID-19 virus from duplicating in your body. They can help you if you’re at high risk for serious complications or sickness from COVID. A Medicare prescription drug plan (Part D) covers oral antivirals. You may have to pay a deductible, copay, or coinsurance depending on your Part D plan.
If you’re unable to get to your doctor’s office because of COVID symptoms, you can opt to see a healthcare provider using online video platforms on your phone or computer. Once you meet your Part B deductible, you’ll pay 20% of the Medicare-approved amount for the telehealth service. If you have a Medicare Supplement plan, it will reduce your out-of-pocket costs.
Note that after December 31, 2024, most telehealth services will require you to be in a rural area for coverage.
If your doctor believes you need hospital care to treat your COVID-related conditions, Medicare will pay for your hospital stay. However, you’ll still need to pay any necessary deductibles, copays, and coinsurance. Medicare Part A covers hospital care. In 2025, your costs will be:
A per-stay deductible of $1,676
Coinsurance of $419 every day after your 60th day
Coinsurance of $838 every day after your 90th day
Certain Medigap plans can help pay for these costs.
Medicare Advantage plans may cover these services differently depending on what plan you have. For example, some policies could ask you to pay a cost for lab tests. Also, if you have a Flex card or OTC card, you may be able to order COVID tests with your included benefits. Download the OTC catalog app to order tests straight to your door. Make sure you familiarize yourself with your summary of benefits or contact your insurance provider with any questions about COVID-related services.
You can also reach out to one of our dedicated Medicare Advisors or Advocates to learn about how your plan covers services related to COVID. Get in touch with us at 855-900-2427 or schedule a time to talk for free, personalized support.
