As the nation faces a state of emergency, seniors – some of the most at-risk for the Coronavirus – ought to be aware of what their Medicare coverage entails. If you become infected with the virus, how does your plan cover treatment? And with many shelter-in-place orders underway during this public health crisis, what does that mean for your coverage?
Rest assured that various changes have been made to ensure Medicare beneficiaries receive proper care – for COVID-19 or any other healthcare needs – without incurring additional costs. Medicare services have expanded, many costs have been waived, and policy requirements have been relaxed.
Here’s what you need to know.
Coronavirus Testing, Vaccines and Associated Costs
If you suspect you are sick and in need of a coronavirus test, your test is covered under Part B – for both traditional Medicare beneficiaries and Medicare Advantage enrollees. All associated copayments, deductibles, and physician visits have been waived. If outpatient treatment is required for COVID-19, Part B also covers outpatient services with usual cost-sharing in place. If a vaccine becomes available for the virus, beneficiaries can also receive coverage under the CARES Act.
Hospitalization & Nursing Facilities
Under Part A, hospitalization is covered with standard cost-sharing. Beneficiaries with COVID-19 will not incur extra costs for single rooms required for quarantine.
One major policy change is that patients in need of treatment at a skilled nursing facility will be covered by Medicare, irrespective of prior hospitalization, for up to 20 days. This allows patients to receive necessary care in the face of overcrowded hospitals during the crisis. After 20 days, patients will have a daily co-pay of $176.
Hospital and skilled nursing facility costs for Medicare Advantage enrollees may vary by plan and depending on length of stay. Most supplemental Medigap policies pick up costs not covered under Medicare A and B.
Out-of-Network and Increased Telehealth Coverage
In light of social distancing and shelter-in-place orders, beneficiaries may use out-of-network facilities at no additional cost. The Centers for Medicare and Medicaid have advised Medicare Advantage and Part D plans with network restrictions to cover services from out-of-network facilities while offering in-network rates.
Several requirements and restrictions on telehealth coverage have also been waived, allowing beneficiaries to receive in-home video coverage from doctors under Part B. Providers are permitted to lower or waive cost-sharing for these services.
Prescription Drug Supplies
Though Part D plans generally place restrictions on the amount of covered prescription drugs that can be ordered, under the CARES Act plans are now required to allow enrollees to order up to a three-month supply. CMS is also allowing – though not requiring – Part D plans with preferred pharmacy networks to relax delivery restrictions and waive additional costs for out-of-network refills.
Lost a Job and in Need of Medicare?
Individuals past age 65 who are facing job and employer-provided group health insurance losses may qualify for a special enrollment period for up to eight months after their coverage ends. They can start the application process by calling their local Social Security office. Those who recently turned 65 or will soon turn 65, on the other hand, qualify for an initial enrollment period in Medicare within three months of their birthday.
Stay Safe & Be Informed
As we continue to navigate this unprecedented health crisis, know that several resources are available to you. You can access tips for prevention, additional details on your coverage and more on Medicare’s website.
As an insurance agency, you want to make sure you are staying informed with the latest information for your clients. A local North Carolina Medicare FMO can help! For more information on how we can help market your insurance company, call us at 919-460-6073 or email us at [email protected].
