Medicare Coverage of COVID-19 in Pre-existing Conditions

checkmark Fact checked Contributing expert: Kelly Blackwell - Published: February 26, 2021

 

Many patients are looking to Medicare to understand their coverage during the COVID-19 outbreak. People with certain pre-existing conditions, such as diabetes, heart or chronic respiratory disease, are at greater risk for serious complications if they contract COVID-19.

What you should know:

  • 1 People with some pre-existing conditions are at greater risk for complications and poor health outcomes if they become infected with COVID-19.
  • 2 The key to minimizing the risk of serious COVID-19 infection is to prevent and manage pre-existing conditions as well as possible.
  • 3 Medicare helps by providing a wide range of services, treatments, and medications to help prevent and manage these pre-existing conditions.
  • 4 Medicare Parts A, B, and D provide hospital, medical, and drug coverage. Alternatively, Medicare Advantage (Part C) combines coverage into all-in-one plans. You choose how you want to access Medicare based on preferences, need, and budget.

Using Medicare to minimize the risk of COVID-19 infections

The key to minimizing the risk of serious COVID-19 infection and poor health outcomes is to manage exposure to COVID-19 and pre-existing conditions as well as possible. To that end, Medicare offers a variety of benefits aimed to prevent or treat underlying health issues, so the body can be in the best position possible to fight off COVID-19 if infected. Medicare COVID-19 vaccine coverage is also available to help mitigate the risk of becoming infected in the first place.

For all of the pre-existing conditions listed below, Medicare helps by providing for healthcare professional visits and medication review and management. How much you pay for preventive care, medication coverage, and treatment benefits depends on the type of Medicare health plan you choose.

Original Medicare Parts A and B help cover things like in-patient hospitalization, doctor’s visits, and medically necessary care, as well as some preventive services. Deductibles and coinsurance payments apply, and there is always a premium for Part B, regardless of which type of Medicare plan you choose. Medicare Advantage plans (Part C) are all-in-one plans which offer the same benefits as Original Medicare, plus more coverage for things such as dental, hearing, vision, and fitness programs. A drug coverage plan (Part D) can be purchased separately if you choose Original Medicare, or will most likely be bundled into the benefits provided from a Medicare Advantage plan.

If you have one of the pre-existing conditions listed here, you will already have a good idea of what types of supplies, medications, and healthcare visits you need in order to be well managed. It is important to consider your preferences, needs, and budget when you choose a Medicare plan. 

How does Medicare cover heart disease?

COVID-19 puts stress on the heart and blood vessels because of the inflammation it causes. The heart and lungs are interdependent, so as a respiratory disease, a COVID-19 that affects your lungs can also adversely affect your heart.

Medicare helps with the increased COVID-19 complication risk from heart disease by paying for a cardiovascular disease screening every five years to help with early detection and promotion of lifestyle changes. Once per year, Medicare Part B provides a prevention benefit that includes a doctor’s visit for cardiovascular behavioral therapy to discuss ways you can lower your risk for heart disease. Medicare covers doctor visits, including cardiologists, diagnostic tests, medications, and surgery for cardiovascular disease. 

Medicare Part B helps cover cardiac rehabilitation programs that provide education, counseling, and exercise if you have certain cardiovascular conditions such as, a heart attack within the last year, bypass or heart valve surgery, or stable chronic heart failure. 

Medications are usually required to manage heart disease. If you have Medicare Parts A and B, you will need to purchase Part D for drug coverage. Alternatively, Medicare Advantage plans provide all the same services as Original Medicare, and usually include a drug coverage benefit.

How does Medicare cover chronic respiratory disease?

COVID-19 is a respiratory disease. If you have asthma, chronic obstructive pulmonary disease (COPD), or any other type of lung disease, and if you contract COVID-19, you are at greater risk for poor outcomes and a more severe course of illness. Medicare helps with the increased risk from chronic respiratory disease by providing coverage for doctor visits, including your pulmonologist, durable medical equipment (DME) and supplies, and medications. Part B Helps pay for a comprehensive pulmonary rehabilitation program if you have moderate to severe COPD with the goal of helping you breathe better, get stronger, and live more independently.

If your doctor prescribes oxygen for you to use at home, Medicare pays for the oxygen and accessories as DME. Medications such as inhalers, and equipment such as nebulizers are covered by Medicare Part B plus Part D, or by a Medicare Advantage plan (Part C) with approved providers and referrals.

How does Medicare cover diabetes?

People who have diabetes or who are at risk for diabetes may experience more complications and poor outcomes if they contract COVID-19. This is due to high blood sugar, immune system problems, and insulin resistance. Medicare helps with the increased risk from diabetes by offering coverage of diabetic supplies, services, and a prevention program.

Some of the diabetes benefits Medicare Part B covers include:

  • Diabetic screening tests if you are at an elevated risk of developing diabetes
  • Outpatient diabetes self-management training (DSMT) if you’ve been diagnosed with diabetes
  • Equipment to help monitor blood sugar
  • An external insulin pump if you qualify for it

For a comprehensive look at these benefits, visit Medicare.gov.

If you join a Medicare drug plan (Part D) or a Medicare Advantage plan (Part C) that participates in the new insulin savings model (effective the beginning of January, 2021), you may have access to many types of insulin for no more than $35 for a 30-day supply. This senior savings model allows you to choose among drug plans that offer insulin at a predictable, low cost.

How does Medicare cover depression and anxiety?

There is a strong relationship between our emotional, social, and physical well-being. People who struggle with depression or anxiety tend to have symptoms related to stress such as weakened immune systems and high blood pressure, which increases the risk for complications and poor outcomes if infected with COVID-19. Medicare helps with the increased risk of depression and anxiety by providing mental health benefits, including depression screening, in-patient and out-patient behavioral health care, medication coverage, and counseling.

If you require hospitalization to stabilize your mental health, Medicare Part A helps pay for inpatient care in a general or psychiatric hospital. Coinsurance and deductibles apply.

Part B helps pay for a number of outpatient services and visits including:

  • Individual and group counseling
  • Psychiatric evaluation
  • Medication management

Services are provided by mental healthcare providers with specialized training, in hospital or community outpatient settings. For a more comprehensive look at Medicare mental healthcare benefits, visit Medicare.gov. If you are enrolled in a Medicare Advantage plan, you have access to the same benefits, offered through approved providers. Check your plan’s evidence of coverage for specific information about deductibles, co-pays and maximum out-of-pocket costs.

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Contributing Expert:

Kelly Blackwell, Certified Senior Advisor (CSA)

Kelly Blackwell is a Certified Senior Advisor (CSA)®. She has been a healthcare professional for over 30 years, with experience working as a bedside nurse and as a Clinical Manager. She has a passion for educating, assisting and advising seniors throughout the healthcare process.