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How does Medicare cover the Coronavirus (COVID-19)?


As noted on the Medicare website, the Centers for Medicare and Medicaid Services (CMS) current guidance on coverage related to the novel corona virus COVID-19 is as follows:
  • Medicare Part B and Medicare Advantage plans cover the lab tests for COVID-19 when ordered -- after February 4, 2020 -- by a doctor or another health care provider that accepts Medicare.  You pay no out-of-pocket costs.

  • Medicare covers FDA-authorized COVID-19 antibody (or “serology”) tests if you were diagnosed with a known current or known prior COVID-19 infection or suspected current or suspected past COVID-19 infection.

  • Medicare Part A and Medicare Advantage plans cover all medically necessary hospitalizations.
    This includes if you're diagnosed with COVID-19 and might otherwise have been discharged from the hospital after an inpatient stay, but instead you need to stay in the hospital under quarantine.  You would pay your Medicare plan's deductible and cost-sharing as you would for any Medicare covered hospital stay.

  • At this time, there's no vaccine available against COVID-19.
    However, when a vaccine becomes available, it will be covered by all Medicare Part D prescription drug plans (PDPs) and Medicare Advantage plans that include drug coverage (MAPDs).  Part D plan deductibles and cost-sharing would apply unless there is a change in law.

  • If you have a Medicare Advantage Plan, you have access to these same coverage benefits.
    Medicare allows Medicare Advantage plans to waive cost-sharing for COVID-19 lab tests.
    Many Medicare Advantage plans also offer telehealth benefits beyond the ones described below.
    Check with your Medicare plan about your coverage and costs.

  • Please remain cautious:  Scammers may use the coronavirus national emergency to take advantage of people while they’re distracted.  As always, guard your Medicare card like a credit card, check Medicare claims summary forms for errors, and if someone calls asking for your Medicare Number, hang up!

Telehealth & related services

Medicare has temporarily expanded coverage of telehealth services to respond to the current COVID-19 Public Health Emergency.  These services expand the current telehealth covered services, to help you have access from more places (including your home), with a wider range of communication tools (including smartphones), to interact with a range of providers (such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social worker).

During this time, you will be able to receive a specific set of services through telehealth including evaluation and management visits (common office visits), mental health counseling and preventive health screenings. This will help ensure you are able to visit with your doctor from your home, without having to go to a doctor's office or hospital, which puts you and others at risk of exposure to COVID-19.

  • You may be able to communicate with your doctors or certain other practitioners without necessarily going to the doctor's office in person for a full visit. Medicare pays for “virtual check-ins”—brief, virtual services with your established physician or certain practitioners where the communication isn't related to a medical visit within the previous 7 days and doesn't lead to a medical visit within the next 24 hours (or soonest appointment available).

  • You need to consent verbally to using virtual check-ins and your doctor must document that consent in your medical record before you use this service. You pay your usual Medicare coinsurance and deductible for these services.

  • Medicare also pays for you to communicate with your doctors using online patient portals without going to the doctor's office. Like the virtual check-ins, you must initiate these individual communications.

  • If you live in a rural area, you may use communication technology to have full visits with your doctors. The law requires that these visits take place at specified sites of service, known as telehealth originating sites, and get services using a real-time audio and video communication system at the site to communicate with a remotely located doctor or certain other types of practitioners. Medicare pays for many medical visits through this telehealth benefit.

The Kaiser Family Foundation also adds the following Medicare coverage points:
  • "CMS has given guidance that in the case of a national disaster, emergency declaration, or public health declaration, CMS expects Medicare Part D plans (PDPs and MAPDs) to lift their "refill-too-soon" restrictions (edits) until the termination of the emergency declaration.  Therefore, during COVID-19, Medicare Part D plans may, but are not required to relax their refill rules.  Contact your Medicare Part D plan's member services if you need a prescription refill or an extended refill that would typically be denied due to "refill-too-soon" restrictions.   [And as noted by Medicare, "Medicare Advantage Plans and Prescription Drug Plans may waive or relax prior authorization requirements."]  [You can contact your plan's Member Services department using the toll-free number found on your Member ID card.] 

  • During the period of the declared emergency, if you are affected by the emergency, Medicare Advantage plans are required to cover services at out-of-network facilities that participate in Medicare, and charge you no more than you would pay if you had received care at an in-network facility.

  • Part D plans are required to ensure that you have adequate access to covered Part D drugs at out-of-network pharmacies when you cannot reasonably be expected to use in-network pharmacies. Part D plans may also relax restrictions on various methods of delivery, such as mail or home delivery, to ensure you have access to needed medications if you unable to get to a retail pharmacy.

  • In response to the national emergency declaration related to the coronavirus pandemic, if you need to be transferred to a skilled nursing facility (SNF) as a result of the effect of a disaster or emergency, CMS is waiving the requirement for a 3-day prior hospitalization prior to coverage. If you have recently exhausted your SNF benefits, the waiver from CMS authorizes renewed SNF coverage without first having to start a new benefit period."

Sources include:
https://www.coronavirus.gov/
https://www.medicare.gov/medicare-coronavirus 03/23/2020, 09/23/2020
https://www.cdc.gov/coronavirus/2019-ncov/index.html
https://www.kff.org/medicare/issue-brief/faqs-on-medicare-coverage-and-costs-related-to-covid-19-testing-and-treatment/ 03/19/2020  [with notes, links, and emphasis added]






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Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.