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Will Medicare cover the costs of coronavirus testing or treatment?
Most American seniors have access to zero-cost testing for COVID-19 and fairly manageable out-of-pocket costs if they end up needing treatment for the disease. And supplemental coverage, including Medigap, Medicaid, or an employer's plan, can reduce those out-of-pocket costs to very little or nothing.
Welcome to Medicare Heads Up, a regular feature intended to deliver state and national Medicare-related headlines that will keep consumers abreast of developments that affect their coverage and costs. This week:
On March 18, President Trump signed the Families First Coronavirus Response Act. The new law eliminates Original Medicare and Medicare Advantage cost sharing for medical visits where you are evaluated or tested for coronavirus (including visits where testing is considered but not ordered).
The law applies to physician office visits, telehealth, urgent care, and hospital observation stays. Original Medicare previously covered the coronavirus lab test without cost sharing (as is the case with other lab costs under Original Medicare); Medicare Advantage plans are now also required to do so.
In response to health professionals urging seniors and others at-risk to obtain extended supplies of medications, the Centers for Medicare and Medicaid Services (CMS) has encouraged Part D insurers (including those offering combined Medicare Advantage Prescription Drug plans) to relax “refill too soon” limits so enrollees can obtain the extra medication. A recent Kaiser Family Foundation (KFF) survey of Part D plans found 75 percent of enrollees were in plans covering extended supplies of at least one tier of generic drugs. Meanwhile, only 47 percent were in plans that covered extended brand drugs in at least one tier, and 4 percent had plans allowing extended specialty medications. (These data predate the CMS guidance, meaning more plans may now cover extended medication supplies.) [UPDATE: The Coronavirus Aid, Relief, and Economic Security (CARES) Act was signed into law on March 27, 2020 and required Part D insurers to cover 90-day fills of medications upon request.]
Some people hospitalized for COVID-19 are expected to need additional care at home during their recovery. Earlier this month, Congress expanded Original Medicare coverage in response to the crisis, making telehealth for most Part B services available for all beneficiaries (as opposed to just those in rural areas), and later waiving Medicare cost sharing for coronavirus screening visits and tests. The change did not, however, allow home health care providers to use telehealth. One large home health provider hopes this and other regulations, such as the requirement for patients to be homebound, will change as the industry faces an influx of COVID-19 patients.
Home health care is available to homebound seniors – those requiring a wheelchair or assistance from another person to leave home – who also need intermittent skilled nursing care or physical, speech-language or occupational therapy.
The Health and Human Services Department Office of the Inspector General (OIG) is warning Medicare beneficiaries to be wary of scam artists offering coronavirus tests, often in exchange for personal details such as Medicare or Medicaid identification numbers. The OIG reports that scam artists are targeting seniors through telemarketing, social media, and door-to-door visits – and once they’ve obtained seniors’ Medicare or Medicaid billing information, that information may also be used in other scams. Medicare beneficiaries should never divulge their account information to solicitors by phone or in person.
You may be interested in how much it will cost if you need to be treated for COVID-19. A comparison by KFF found at least half of Medicare Advantage beneficiaries would face higher cost sharing than people with Original Medicare for a hospital stay of five days or longer. Beneficiaries hospitalized three days or less would pay more under Original Medicare. (KFF assumed the individual didn’t also have supplemental coverage from a Medigap plan or employer-sponsored plan.) Medicare Advantage plans typically have copayments for inpatient hospital stays, while people with Original Medicare would owe a single $1,408 deductible for the first 60 days. Both Advantage plan and Original Medicare enrollees would also owe separate cost sharing for physicians’ services. Here’s our look at how Medicare covers the costs of coronavirus testing and treatment.
The Virginia Senate has passed legislation that would allow disabled Medicare beneficiaries to enroll in certain Medigap plans, The bill now goes to Gov. Ralph Northam for his signature. (The House passed the legislation last month.) Under the bill, Medigap insurers would have to offer at least one standardized Medigap plan to disabled beneficiaries who enroll within six months of qualifying for Medicare – and who have both Part A and Part B coverage. (You need both to enroll in Medigap.) If the bill is signed into law, it would also create a six-month window – starting January 1, 2021 – during which disabled residents who are already enrolled in Medicare could apply for Medigap coverage. The new law would not, however, apply to individuals who are enrolled in Medicare prior to age 65 as a result of end-stage renal disease (ESRD).
Josh Schultz has a strong background in Medicare and the Affordable Care Act. He managed a Medicare ombudsman contract at the Medicare Rights Center in New York City, and represented clients in extensive Medicare claims and appeals. In addition to advocacy work, Josh helped implement federal and state health insurance exchanges at the technology firm hCentive. He also has held consulting roles, including as an associate at Sachs Policy Group, where he worked with insurer, hospital and technology clients on Medicare and Medicaid issues.