Cleveland, Ohio – A study conducted by the U.S. Census Bureau revealed that nearly 1 in 4 adults aged 65 and above who have contracted COVID-19 have experienced lingering symptoms, a condition known as long COVID. This condition encompasses a range of health issues that persist for at least four weeks post-infection, such as fatigue, shortness of breath, and cognitive difficulties, among others according to the Centers for Disease Control and Prevention.
Katy Votava, a health expert specializing in Medicare economics, emphasized the unique challenges posed by long COVID due to its novelty and the lack of specialized medical professionals dedicated to its treatment. While Medicare does cover long COVID treatment, access to specialized care may vary depending on the type of Medicare plan individuals have and their geographical location.
Both Original Medicare and Medicare Advantage plans provide coverage for COVID-19 treatment as well as long COVID symptoms, including pulmonary rehabilitation starting in 2022. However, Original Medicare allows individuals to see specialists nationwide, whereas Medicare Advantage plans, managed by private insurance companies, often limit care options to in-network providers within a specific geographic area.
Concerns may arise if individuals with Medicare Advantage plans cannot find an in-network specialist for long COVID treatment. Options include seeking out-of-network providers, potentially incurring higher costs, or requesting prior authorization from the insurer to receive in-network billing for out-of-network care. Navigating these challenges may involve careful consideration of plan networks and potential plan changes during specific enrollment periods.
Medigap, a supplemental insurance option for Original Medicare recipients, can help limit out-of-pocket costs for frequent medical visits. However, securing affordable Medigap policies may become challenging after the initial enrollment period, especially for individuals with preexisting health conditions like long COVID. Despite potential concerns about increased costs associated with long COVID, Medigap underwriting policies have not shown significant changes in acceptance rates for affected individuals.
In summary, individuals dealing with long COVID and navigating Medicare options may need to explore various strategies to ensure access to necessary care while managing healthcare costs effectively. The evolving landscape of healthcare coverage underscores the importance of understanding plan details, seeking expert guidance, and proactively reviewing and adjusting coverage as needed.