Some Medicare beneficiaries who catch Covid-19 may face huge bills for care

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With 74-year-old President Donald Trump testing positive for Covid-19, Medicare beneficiaries may be reminded of their own vulnerability.

For the 62.7 million people enrolled in Medicare —  the majority of whom are age 65 or older —  the coronavirus generally poses a greater health risk. While Congress and regulators have nixed out-of-pocket outlays for testing, the potential cost of treating the virus may pose a greater concern, due to the greater likelihood of individuals in that age group developing complications from the virus.

In the U.S., the pandemic has resulted in more than 7.28 million cases and nearly 208,000 deaths. Among Medicare beneficiaries, there have been more than 1 million cases this year through Aug. 15, according to preliminary data from the Centers for Medicare and Medicaid.

More than 284,000 of those involved hospitalizations. Almost half (49%) of those stays lasted one to seven days, according to the data. Roughly 5% last longer than 30 days.  

While some Medicare beneficiaries have additional insurance that covers the out-of-pocket costs — i.e., copays and deductibles — others pay more than their peers for hospital stays and various medical services.

Although most people recover from the coronavirus without requiring significant medicare care, here are costs that could come with Medicare coverage if treatment is needed.

Basic Medicare costs

About 60% of beneficiaries stick with basic, or original, Medicare. Many of them also have additional coverage — e.g., Medicaid, an employer plan or a supplemental policy (Medigap).

Basic Medicare, which has no cap on out-of-pocket spending, consists of Part A (hospital coverage) and Part B (outpatient care). 

If you don't have additional coverage beyond basic Medicare — 6.1 million beneficiaries did not, at last count — you'd pay a $1,408 Part A deductible if you're admitted to the hospital.

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That would cover the first 60 days per benefit period. Beyond that, daily copays of $352 apply up to the 90th day. Anything above dips from "lifetime reserve" days at a rate of $704 daily. For patients moved to a skilled nursing facility, there is no copay for the first 20 days; it's $176 after that.

Medical services like doctor's visits are delivered through Part B. It has a $198 deductible and beneficiaries typically pay 20% of covered services.

If you have a Medigap policy, many of these costs would be covered, either partially or fully. However, Medigap policies have their own rules for enrolling, which can limit who has access to them. And, they can cost several hundred dollars a month.

Meanwhile, Medicare Part D (prescription drug coverage) also has no cap on out-of-pocket spending. The cost of medicine depends on the specifics of coverage. If there's a deductible with your plan, it can be up to $435.

Advantage Plans

About 24 million Medicare beneficiaries get Parts A and B delivered through an Advantage Plan, which also usually includes prescription drug coverage.

These plans may or may not have a monthly premium on top of what beneficiaries pay for basic Medicare. They also typically have different deductibles and copays from original Medicare, and those costs can vary from plan to plan. 

For instance, while you might not face a Part A deductible of $1,408 for a hospital stay, your Advantage Plan may charge you a daily copay for the time you're an inpatient.

Each [insurer] is offering different types of Covid assistance.

Danielle Roberts

Co-founder of Boomer Benefits

However, for Covid-19 treatment, some plans' standard cost-sharing has been put on hold.

"Each [insurer] is offering different types of Covid assistance," said Danielle Roberts, co-founder of insurance firm Boomer Benefits.

For example, Aetna is waiving cost-sharing for inpatient admission for Covid-19 treatment or health complications associated with the virus through Dec. 31. Humana also is waiving such costs, with no end date for the waiver noted.

Globally, there have been more than 34.3 million coronavirus cases, resulting in more than 1 million deaths.

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