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Medicare updates coverage to help during coronavirus crisis

WASHINGTON — Medicare and Medigap insurance carriers have announced that they are waiving coronavirus-related costs to help enrollees access treatment.

The vast majority of Americans who are on Medicare are over the age of 65, and 12% of recipients are over the age of 85. These Americans are at high risk for serious illness or death from the novel Coronavirus.

Here’s a breakdown of what is currently being covered by Medicare:

— Medicare will cover the lab tests for COVID-19. There will be no out-of-pocket costs for recipients on Medicare Part A and Medicare Part B.

— Medicare will cover all “medically necessary hospitalizations.” This includes those who are diagnosed with COVID-19 and need to stay in the hospital under quarantine when they otherwise may have been discharged.

— If one becomes available, vaccines will be covered by Medicare Part D plans.

— Those with Medicare Advantage Plans will have access to these benefits as well. Cost sharing will be waived for COVID-19 tests. Telehealth benefits may also be available.

Specific Carrier Information for COVID-19

— Aetna

Aetna will cover inpatient hospital stays for coronavirus treatment, other medically related complications. It is waiving cost-sharing and copays for visits related to COVID-19 to help members access necessary care.

— Cigna

Cigna is waiving patient cost-sharing for COVID-19 diagnostic visits, testing and treatment through May 31. Cigna will reimburse health care providers at in-network rates or Medicare rates.

— Humana

Humana previously announced it was waiving consumer costs for COVID-19 testing, and will now waive costs related to subsequent treatment for the coronavirus, including inpatient hospital visits. This applies to vaccines, should one become available. There is no end date to the cost-free coverage.

— Mutual of Omaha

Medicare supplement customers are covered for COVID-19 testing by Medicare Part B. Claims will be paid without disruption.

— ManhattanLife

ManhattanLife stated that testing may be covered “If your policy has an annual wellness or screening benefit, as well as other laboratory benefits.” Hospital admissions depend on the type of coverage maintained with ManhattanLife.

— UnitedHealthcare

Member cost-sharing for the treatment of COVID-19 is waived through May 31 for fully-insured Commercial, Medicare Advantage and Medicaid plans. Cost-sharing for in-network non-COVID-19 telehealth visits is waived for some plans, including Medicare Advantage and Medicaid through June 18.

— BlueCross BlueShield.

Coverage depends on the area. Michigan Blue Cross is waiving all member copays, deductibles and coinsurance for COVID-19 testing. The lab tests must be physician-authorized, and testing and associated services must be consistent with CDC guidelines. Michigan Blue Cross will also waive member cost sharing for all COVID-19 treatment through June 30. For more information, go to https://www.bcbs.com/coronavirus-updates.

Here’s a look at what enrollees can expect from Medicare, some problems to look out for, and some additional changes that advocates think still need to be made.

Does Medicare cover COVID-19 testing?

Diagnostic tests will be covered under Medicare Part B if ordered by a health care provider that accepts Medicare. Most carriers have waived copays and any cost-sharing for tests.

Will Medicare cover inpatient hospital treatment?

All outpatient services are covered under Medicare Part B. Part A rules will cover any inpatient treatment needed. If you have a Medicare Advantage Plan, you will have access to these benefits as well.

Will Medicare cover a COVID-19 vaccination?

A vaccine is not yet available for COVID-19, but should one become available, it will be covered by all Medicare Prescription Drug Plans (Part D). These plans usually only apply to in-network providers, but this has changed due to the state of emergency.

Usually enrollees will pay more out of network, but the CMS announced they will require out-of-network facilities that participate in Medicare to charge in-network rates.

Can prescriptions be extended during the crisis?

A provision in the CARES Act requires both standalone drug plans and Part D plans to provide up to a 3-month supply of covered Part D drugs to enrollees who request it. Medicare Part D plans usually have limits on the amount enrollees can receive and refill frequency.

For drugs covered under Part B, Medicare and its contractors will make case-by-case decisions on whether to supply drugs for more than a 30-day period.

Rules vary across providers. It’s best to check with your individual plan or pharmacy provider to see what actions you can take.

What telehealth benefits will be covered by Medicare and will beneficiaries pay?

Prior to this pandemic, Medicare would only pay for telehealth on a limited basis, like when patients are in a rural area or go to a medical facility for telehealth services. However under a new waiver, Medicare can pay for office, hospital and other telehealth visits as of March 6.

This includes providers such as doctors, nurses practitioners, clinical psychologists and licensed clinical social workers, according to the CMS. The HHS Office of Inspector General is also relaxing restrictions so healthcare providers can reduce or waive cost-sharing for telehealth visits covered by Medicare.

This was done to help Medicare beneficiaries, many of whom are at high risk for COVID-19 visit their doctor without putting themselves at risk.

What other Medicare changes are on the horizon?

Medicare advocates are striving for even wider changes to help enrollees. Some of these include:

— Waiving Part A deductibles for those hospitalized with COVID-19 and lack supplemental insurance.

— Allowing Part D beneficiaries to order a three-month supply of necessary prescription medications.

— Waiving Part B late enrollment penalties.

— Capping the cost of prescription drugs under Part D.

— Waiving the 24-month waiting period for benefits for those under the age of 65 awarded Social Security Disability.

Where can I access more information?

Some resources for updated Medicare and COVID-19 information include:

— Kaiser Family Foundation’s FAQ

— The COVID-19 page on Medicare.gov

Social Security Administration field offices are closed to the public for most services during the crisis, but you can connect with the agency by phone (800-772-1213 or TTY 800-325-0778) or online. If you need help with Medicare enrollment during the crisis, try the State Health Insurance Assistance Program.

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