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What You Need to Know About Coronavirus and Medicare Coverage

We will provide updates and information on this page as available. If you have questions about your Medicare coverage and the coronavirus national emergency, please review the resources below and call our national helpline at 800-333-4114.

12/11/2020 Update: A COVID-19 vaccine has been authorized for limited emergency use. Relevant changes have been made below.

As the number of cases of COVID-19 (also called coronavirus) increases, so does the importance of programs like Medicare in helping older adults, people with disabilities, and their families build and maintain their health and economic security. Accordingly, policymakers are taking critical steps to ensure program preparedness, keep beneficiaries and the public informed, and facilitate timely access to appropriate care.

The Centers for Medicare & Medicaid Services (CMS) is working to address the spread of the disease and inform people with Medicare about the services that Medicare covers. The Centers for Disease Control and Prevention (CDC) has identified older adults and people with serious chronic medical conditions like heart disease, diabetes, and lung disease as being at higher risk from the virus.

In general, Medicare covers medically necessary items and services that a beneficiary receives from a provider who accepts Original Medicare or is in-network for the beneficiary’s Medicare Advantage Plan. Medicare Advantage Plans must cover everything that Original Medicare does, but they can do so with different costs and restrictions.

Medicare-covered services related to coronavirus include

Note: If a beneficiary has Medicare and Medicaid, Medicaid may cover additional services as long as the beneficiary sees providers who accept Medicaid. Contact the local Medicaid office for more information.

Accessing services during public health emergency
During emergencies, Medicare Advantage Plans must work to maintain access to health care services and prescription drugs for plan members living in affected areas. Plans must meet certain requirements following the declaration of a disaster, emergency, or public health emergency. Medicare Advantage Plans must:
  • Allow beneficiaries to receive health care services at out-of-network doctor’s offices, hospitals, and other facilities Charge in-network cost-sharing amounts for services received out-of-network
  • Waive referral requirements
  • Suspend rules requiring the beneficiary tell the plan before getting certain kinds of care or prescription drugs, if failing to contact the plan ahead of time could raise costs or limit access to care
Part D plans must:
  • Cover formulary Part D drugs filled at out-of-network pharmacies
    • Part D plans must do this when beneficiary cannot be expected to get covered Part D drugs at an in-network pharmacy
  • Cover up to 90-day supply (or length of the prescription, whichever is shorter) of prescription at beneficiary’s request
    • Plans cannot impose quantity limits on a drug that would prevent a beneficiary from getting full 90-day supply, as long as they have prescription for that amount
    • Some safety checks are still in place to prevent unsafe doses of opioids
  • Make other needed changes to ensure beneficiaries can access their medication without interruption
    • Plans have different options for how to do this, such as lifting restrictions that prevent a beneficiary from filling a prescription too soon
Medicare has also given plans the flexibility to make optional changes. These optional changes include:
  • Removing prior authorization requirements for certain services
  • Relaxing restrictions on home or mail delivery of prescription drugs
  • Relaxing restrictions on refilling prescriptions too soon
  • Making mid-year changes that would provide more generous coverage (lower cost-sharing) or adding additional benefits
  • Not disenrolling beneficiaries who:
    • Fail to pay premiums
    • Live outside of plan service area for more than six months
    • No longer qualify for specialized type of plan known as Special Needs Plan (SNP)
Every Medicare Advantage and Part D plan is different. Beneficiaries should contact their plan directly to learn about how it covers services related to coronavirus. Many other adjustments have been made to the Medicare program that may change the way a beneficiary receives care or interacts with their providers during the public health emergency. Beneficiaries should be sure to ask their provider if anything has changed that may impact their care or coverage.
For more information or help accessing Medicare benefits:

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