Does Medicare cover long COVID?


Nearly 1 in 4 adults age 65 and over who have had COVID-19 have experienced long COVID symptoms afterward, according to data from the U.S. Census Bureau.

Long COVID includes a wide list of lingering health problems that may occur at least four weeks after being infected with COVID-19, according to the Centers for Disease Control and Prevention. These symptoms may include fatigue, shortness of breath, cough, chest pain, trouble concentrating, headache, sleep issues, changes in smell or taste, depression or anxiety, and joint pain.

“The big challenge of long COVID is that it is so new,” says Katy Votava, who holds a doctorate in health economics and nursing and is president and founder of Goodcare, a consulting firm focused on the economics of Medicare. “There really aren’t that many specialists that deal with it.”

Medicare covers treatment for long COVID, including pulmonary rehabilitation services related to symptoms after a COVID-19 infection. The ability to see a doctor who specializes in long COVID treatment, however, may depend on where you live and whether you have Original Medicare or Medicare Advantage.

Original Medicare vs. Medicare Advantage long COVID coverage

Both Original Medicare and Medicare Advantage cover treatment for COVID-19 as well as treatment for the symptoms related to long COVID. This includes, starting in 2022, coverage for pulmonary rehabilitation for people who had (or thought they had) COVID and who continued to have symptoms afterward.

If you have Original Medicare, you can see any specialist anywhere in the country who accepts Medicare coverage. This can be important if you’d like to consult a long COVID doctor or clinic that isn’t nearby.

On the flip side, Medicare Advantage, which is sold by private health insurance companies, usually requires members to get their care from providers and facilities within a network, which may be restricted to a geographic area.

“If you have one of the HMO [Medicare] Advantage plans, I’ve seen that to be more of an issue, where you have to get a referral from your primary doctor to see an in-network specialist,” says Garrett Ball, owner of Secure Medicare Solutions, an independent Medicare insurance agency. “But I think, in just the last six to 12 months, there’s probably been more access to doctors that are treating long COVID.”

For this reason, it’s important to check a Medicare Advantage plan’s network before you sign up so you can make sure your doctors — and any specialists you want to see — are included.

“A lot of this is constrained by where you live around the country,” says Sean Creighton, managing director at health care consultancy Avalere. If you’re in a large urban area, he says, you’re more likely to find a specialist, no matter which version of Medicare you have.

What if a long COVID specialist is out-of-network?

If you have a Medicare Advantage plan and there isn’t a long COVID specialist in-network, you have options. If you have a plan that allows you to see out-of-network providers, such as a PPO plan, you may be able to see a specialist who isn’t in-network and pay more out of pocket. If you have an HMO plan that doesn’t…



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