Becoming ill during a stressful time, like during a global pandemic, can certainly be a natural cause for concern. One way to combat worry is to better understand what would happen IF you became ill and needed medical care and access to medications. Being familiar with what your plan covers will help you feel prepared for what comes your way, specifically around the changing COVID-19 plan coverages and limitations.
I Lost My Job. Can I Enroll in Medicare Now?
If you are over the age of 65, lost your job due to the coronavirus pandemic and, as such, lost your health insurance coverage, you might qualify for what’s called a “Special Enrollment Period,” and you can read more about them here. These periods allow you to enroll in Medicare during a particular window of time after a special event, like the loss of employer-provided insurance. SEPs can be tricky to navigate, so feel free to reach out to our team of advisors to help you navigate finding the right plan for you. You can also explore our New to Medicare Resource Library for lots of great information about enrolling in Medicare. It will be important to make sure you have the proper health insurance coverage in place for your needs, so don’t delay taking action to make sure you and your family are protected.
What Coverage Do I Have for COVID-19 Testing?
The U.S. Department of Health and Human Services determined that the test for COVID-19 is an essential health benefit, which means Medicare and Medicaid will cover the cost of the test for beneficiaries who are suspected to carry the virus. All tests must be ordered through a doctor, so you cannot order the test directly as an individual.
Medicare beneficiaries will not be charged the Part B deductible or coinsurance for COVID-19 testing, nor will you be charged any cost-sharing amounts for COVID-19 testing-related services, like associated physician visits, hospital observation, telehealth visits, or emergency room visits.
What Coverage Do I Have for COVID-19 Treatment?
This question is tricky, as there actually is no treatment or cure for COVID-19. There are, however, treatments for the symptoms of the virus. This means that while you will have certain coverage for treatments, depending on your Medicare plan type, it may be everything that is already outlined and covered under your existing plan. We outline what Medicare covers in this article, but below is a quick summary of coverage. The Centers for Medicare and Medicaid Services (CMS) has permitted Medicare Advantage plans to waive or reduce cost-sharing for treatments, and many insurance companies have done so. Certain Supplement plans have also waived cost-sharing for treatments.
Medicare Part A
In general, Medicare Part A covers the following:
- Hospital care
- Skilled nursing facility care
- Nursing home care (as long as custodial care isn’t the only care you need)
- Home health services
Medicare Part B
Part B coverage includes items like:
- Clinical research
- Ambulance services
- Durable medical equipment (DME)
- Mental health
- Inpatient Care
- Outpatient Care
- Partial hospitalization
- Getting a second opinion before surgery
- Limited outpatient prescription drugs
If a vaccine for COVID-19 became available, it would be covered by Medicare Part B under the CARES (Coronavirus Aid, Relief, and Economic Security) Act signed into law in March 2020.
What if I need to receive care from an Out-of-Network Provider?
If you are on a Medicare Advantage plan, you’re likely familiar with the restrictions on receiving care from out-of-network providers. CMS changed these restrictions during the coronavirus pandemic. Under CMS’s recommendation, Medicare Advantage plans must charge the same rates for services provided to MA beneficiaries at out-of-network facilities as they do for in-network providers under the condition that the out-of-network provider participates in Medicare.
Changes to Pharmacy and Prescription Medication Coverage
During the pandemic, CMS is loosening restrictions on Medicare Part D drug plans that usually require you to fill prescriptions at preferred pharmacies or mail-order pharmacies. Please note, however, that this is not an across-the-board change, so be sure to check with your prescription medication insurance provider before attempting to fill your prescription at a new location. Because leading health experts recommend that all individuals have a 90-day supply of medication available at home (in an effort to reduce trips out of the house, especially for older individuals), the CARES Act includes a provision that requires all Part D and MAPD plans to fulfill 90-day supplies of covered medications to enrollees who request it.
I cannot get to my doctor right now. What are my options?
Good news – CMS has broadened the permissions surrounding telehealth. Under recent legislation, Medicare is now able to cover telemedicine for a much larger group of beneficiaries. Prior to this legislation, Medicare-covered telemedicine was limited to primarily rural areas where access to care is limited. Under the bill, Medicare beneficiaries can receive care from any doctor (not just visits that are related to COVID-19) via phone or video at no additional cost as a way to expand care during this time while also keeping more people at home–especially individuals over the age of 65. This is particularly impactful for beneficiaries enrolled in Original Medicare plans. If you are enrolled in a Medicare Advantage plan, you may already have access to telemedicine benefits, so consult your insurance company for details.
If you are not yet a RetireMEDiQ client and have questions about what this may mean for you as you approach Medicare, contact our team of expert advisors at 1-855-981-8611.