Medicare Part B covers the SARS-CoV-2 antibody test. People with this coverage pay nothing for the antibody test as long as a Medicare-enrolled doctor orders it.
The coronavirus antibody test determines if a person has developed an immune response to the viral infection, SARS-CoV-2.
While many Medicare services involve out-of-pocket costs, the antibody test is free of charge.
This article describes Medicare coverage of the antibody test and other healthcare for COVID-19 and the associated out-of-pocket costs.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
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Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
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Deductible:Â This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
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Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
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Copayment:Â This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Coverage for the coronavirus antibody test
Original Medicare includes Part A, which covers inpatient care, and Part B, covering outpatient services.
In 2024, Part B covers the FDA-authorized SARS-CoV-2 antibody test, sometimes called the serology test, if a person has a current or previous coronavirus diagnosis or a doctor suspects a current or prior infection.
Medicare Advantage, also known as Medicare Part C, provides the same coverage as original Medicare parts A and B, including the antibody test.
Once someone develops SARS-CoV-2, their body makes antibodies against the virus that causes the disease within 1 to 3 weeks. Because of the time necessary to make antibodies, the test may not show a current infection.
If the test finds antibodies, it indicates a person may have some protection against reinfection. Antibody levels may stay stable for up to eight months before declining.
People with original Medicare or Medicare Advantage do not have to pay any out-of-pocket costs for the test.
COVID-19 test availability
In 2020, the National Institutes of Health invested millions of dollars in technologies to substantially increase the type and number of available tests.
As the United States government endeavored to increase testing availability, it also relaxed Medicare rules to make it easier for people to get access to the tests.
Although the impact of coronavirus has changed over time, transmission rates are still increasing periodically.
As of 2024, Original Medicare continues to cover FDA-authorized antibody tests for people with a current or previous coronavirus infection or people whose doctor suspects a current or previous infection.
A Medicare-enrolled doctor must order the antibody test. People can then get them from a laboratory or a hospital.
Other Medicare coronavirus coverage
Original Medicare covers the following coronavirus services:
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the 2023 to 2024 formula of the Moderna or Pfizer-BioNTech COVID-19
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diagnostic lab tests for COVID-19
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oral antivirals
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monoclonal antibody treatments
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medically necessary hospitalizations
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expanded telehealth services
Medicare Advantage may also cover these services, but deductibles and other out-of-pocket expenses may apply.
Medigap
Some people with original Medicare have a Medigap policy, which is Medicare supplement insurance.
These plans cover 50% to 100% of parts A and B out-of-pocket costs. The coverage would include any healthcare costs related to COVID-19.
Part D
Medicare Part D covers outpatient prescription drugs and is available to those with original Medicare. It is also included in some Medicare Advantage plans.
People may qualify for oral antiviral drugs if they test positive for COVID-19 and have a high risk of becoming very sick. Medicare Part D will cover these oral antiviral drugs.
Depending on their plan, people may need to pay deductibles, copayments, and coinsurance.
Out-of-Pocket coronavirus costs
Both original Medicare and Medicare Advantage have out-of-pocket costs.
Part A costs
In 2024, hospitalization costs include:
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$1,632 deductible for each benefit period
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$0 copayment for days 1 to 60 of each benefit period
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$408 copayment per day for days 61 to 90 of each benefit period
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$816 copayment per day for each lifetime reserve day of each benefit period
A benefit period starts the day a person enters a hospital as an inpatient and ends the day after they have been home from the hospital for 60 days.
Once someone has been in a hospital for 90 days, Medicare provides coverage of an additional 60 days, known as lifetime reserve days. After this, people must pay all costs.
Part B costs
Part B covers the entire cost of any tests to diagnose COVID-19. Medicare Part B also covers the entire cost of the 2023 to 2024 formula of the COVID-19 vaccination.
Medicare Advantage
Private insurance companies administer Medicare Advantage plans, and therefore, out-of-pocket costs relating to COVID-19 are different under these plans from those of original Medicare.
Because people with a Medicare Advantage plan pay Part B premiums, they receive complete coverage of COVID-19 tests and other services.
About COVID-19
The virus SARS-CoV-2 can cause the condition or disease that is known as COVID-19. COVID-19 is highly contagious and may produce symptoms 2 to 14 days after exposure. Symptoms may include:
A person may need emergency medical treatment if they have any of the following symptoms:
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trouble breathing
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sudden confusion
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persistent chest pain or pressure
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pale, gray, or blue lips or skin
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inability to stay awake
Getting information and advice
Although COVID-19 is no longer a public health emergency, people may still need sources for sound advice. To avoid misleading information, a person can consult reliable medical and government websites, such as:
Coronavirus resources
For more advice on COVID-19 prevention and treatment, visit our coronavirus hub.
Summary
Medicare covers the SARS-CoV-2 antibody test, other tests a doctor needs to diagnose COVID-19, and the current vaccination.
The antibody test may indicate a person has had the virus in the past, while the other tests may show whether they currently have it. All people with Medicare may get the tests free of charge.
COVID-19 coverage also includes hospitalization. The out-of-pocket costs of original Medicare and Medicare Advantage may differ.
View the original article on Medical News Today
