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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:
CMS is allowing any healthcare professional to order a coronavirus test as long as they’re allowed to order one under state law. Medicare previously required coronavirus tests to be ordered by an established healthcare provider (and this meant that if you didn’t have one, you couldn’t get a test without being seen in an office). Because a significant number of Medicare beneficiaries get their care from urgent care centers, community medical clinics, or the hospital, CMS is temporarily paying for the coronavirus test regardless of who orders it.
This means Medicare will now pay for coronavirus tests occurring at community testing sites, hospital outpatient departments, or independent labs like Quest or LabCorp. In addition, CMS is allowing pharmacists to work with physicians to order coronavirus tests, meaning your pharmacy may be able to test you for coronavirus.
Because symptoms of COVID-19 can overlap with the flu and vice versa, CMS is also relaxing its ordering requirements for influenza and respiratory syncytial virus (a common type of respiratory virus) if tests for those viruses are ordered together with a coronavirus test. These other tests would have to be used as part of diagnosing or ruling out COVID-19 or to identify patients who may now have immunity.
To promote coronavirus testing, CMS also announced it will pay hospitals and practitioners a specimen collection fee when they test patients for coronavirus, even if the patient doesn’t receive any other medical treatment. Previously, only independent laboratories received this payment.
CMS announced on April 30 that Medicare will pay the same rates for some telephone-based visits that it pays for in-person care, and it will apply this change retroactively, to visits beginning on March 1. Due to the coronavirus, CMS previously said Medicare would pay for telephone-based visits, but it hadn’t been paying the same rate as in-person care. The change means healthcare providers will have a greater incentive to provide care over the phone – which some providers prefer to using telehealth, which requires a video connection.
In addition to primary care, CMS is now allowing certain behavioral health services to be provided by telephone. Medicare patients who are enrolled in an opioid treatment program (OTP) receive therapy, counseling, and periodic assessments. During the coronavirus emergency, CMS will pay for these services when they occur by phone or telehealth.
Medicare will also begin paying for certain types of individual and group psychotherapy and patient education occurring by phone or telehealth, for beneficiaries receiving mental health treatment in a partial hospitalization program. Effective March 1, patients can receive these services in a home, or in an offsite “temporary expansion” location associated with a community mental health center or hospital.
Under a new waiver granted by CMS, all Medicare practitioners can bill for telehealth for the duration of the coronavirus emergency. Under previous federal legislation, CMS expanded Original Medicare coverage of telehealth to include all beneficiaries and allow them to make telehealth visits from home, but those rules still only allowed a few types of providers specified in the law to bill for telehealth. The waiver means that in addition to medical visits, patients can receive physical, occupational, and speech-language therapy using telehealth, for as long as the emergency lasts.
CMS also said that while it previously only added to services that can be provided through telehealth by issuing a formal regulation, it would make future changes through less formal announcements. This will allow CMS to quickly expand telehealth coverage to more services in the future.
During the pandemic, Medicare patients can receive telehealth care at home. But under normal circumstances, patients must have their telehealth visits from an “originating site” location at a hospital or community health center. When this happens, Medicare pays an extra amount beyond the clinician’s fee to the facility. CMS has announced it will continue paying this additional amount when patients are treated in their homes. People with Original Medicare have to pay a 20 percent coinsurance for outpatient care – including telehealth – unless the visit is related to testing or treatment for COVID-19. As a result, beneficiaries will pay more when they receive telehealth care from providers who normally practice in a hospital (many people have Medigap plans that will cover some or all of the coinsurance cost).
As businesses reopen and Americans resume some of their normal activities, you may want to get tested to see whether you’ve been exposed to coronavirus and developed some immune response (meaning you may not be at immediate risk for reinfection). CMS has announced that Medicare and Medicaid will immediately cover coronavirus serology (antibody) testing. Clinical diagnostic tests are covered at 100 percent under Original Medicare, but Medicare Advantage plans may impose cost sharing for this service.
While it’s important for beneficiaries to be tested for antibodies so public health authorities can use the information to respond to the pandemic, it’s not yet known whether having antibodies means you’re immune from a future coronavirus infection, or how long immunity lasts.
Federal officials have stopped accepting new applications from providers seeking loans from Medicare under the Accelerated and Advance Payment (AAP) program. Until April 27, CMS had been paying some Medicare Part B providers in advance – based on their past Medicare payments – to help them weather decreased patient volume during the coronavirus. The program paid over $40 billion to Part B providers before CMS stopped it, citing the other federal assistance now available.
More than half of physicians work in independent practices, according to the American Medical Association (AMA), and many face a financial crisis because people are delaying care. CMS has continued making some payments to hospitals under the program after stopping payments to outpatient providers. The AMA is calling for CMS to reopen the program to Part B applications, and expand it to include Medicaid claims.
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.