Over 51 million adults age 65 and older are at higher risk of developing a serious illness if they become infected with COVID-19. Most of these seniors rely on Medicare to pay for medical care and many are concerned about how much Medicare will cover for COVID-19 testing and treatment. Through this article, we will present the Medicare covered services and related costs, as well as the impact of various federal coronavirus relief regulations passed by Congress.

The Medicare Covered COVID-19 Expenses

Medicare already covers many healthcare costs, and additional regulations have expanded some of this care. Here is a list of all services now covered and their associated costs:

• Medicare covers COVID-19 testing under Medicare Part B and are not required to pay the deductible or any coinsurance for this tests. In addition, the Families First Coronavirus Response Act eliminates beneficiary cost-sharing for test-related services including the associated physician visit or other outpatient visit, including an emergency room visit. This law also eliminates cost-sharing for Medicare Advantage enrollees for both the test and test related services and removes any preauthorization or utilization management requirements.
• Inpatient Hospitalization. There has been no change in the coverage for inpatient Medicare covers inpatient hospital stays, but all deductibles and copays are still in place.
• Skilled Nursing Facility (SNF). The Center for Medicare Services (CMS) is waiving the 3-day prior hospitalization requirement for coverage of SNF services. For beneficiaries who have recently exhausted their SNF benefits, this waiver authorizes renewed SFN coverage without having to start a new benefits period. Standard copayments and deductibles for initial and extended SNF days remain the same. For those with supplemental coverage, some of these costs will be paid through those plans.
• As of this writing, there is no vaccine for COVID-19. If one becomes available, the Medicare Prescription Drug Plan Part D will cover the expense. Without this plan or a Medicare Advantage Plan, you may need to pay out-of-pocket for this vaccine.

Medicare and Telehealth 

Through the Coronavirus Preparedness and Response Supplemental Appropriations Act, (CARES) the Secretary of Health and Human Services has temporarily waived certain restrictions on Medicare coverage of telehealth service. This waiver allows all beneficiaries, regardless of geographic location, to:

• Receive telehealth services;
• Remain in their homes for telehealth visits reimbursed by Medicare; and
• Have telehealth visits be delivered via smartphone with real-time audio/video interactive capabilities in lieu of other equipment.

This law also removes the requirement that providers of telehealth services have treated the beneficiary receiving these services in the last three years. A separate provision in the CARES Act allows federally qualified health centers and rural health clinics to provide telehealth services to Medicare beneficiaries during the COVID-19 emergency period.

The covered services include:

• Scheduled doctor’s visits;
• Evaluation and management visits;
• Mental health counseling; and
• Preventative visits.

These services are provided under Medicare Part B, so the standard Part B deductions and coinsurance payments still apply. The good news is that the HHS Office of Inspector General is providing flexibility for providers to reduce or waive the cost-sharing for telehealth visits during this public health emergency. It is important to note that Medicare Advantage Plans are able to offer telehealth benefits not covered by traditional Medicare. 

Extended Supplies of Medication

Under the CAREs act the limitations on the amount of medication that people can receive has been adjusted. Under Part D Plans, including Medicare Advantage Plans, can now provide up to a 90 day (3 month) supply of covered Part D drugs for enrollees who request it.

Additional Medicare Billing Codes

In an effort to assure that Medicare enrollees receive all of the care they need, new codes have been added to allow healthcare facilities to bill for necessary services related to COVID-19.

Alliance Insurance Can Help

At Alliance, we have assisted Medicare-eligible adults to consider their options in plans and supplemental insurances. Let our Medicare experts help you by reviewing your current plan and presenting options if it no longer meets your needs. If you are new to the Medicare program, you don’t have to address the enrollment challenges alone. We represent the best insurance carriers in Florida and can help you select the best option for your needs.