Joel Mekler | Medicare Moments: What it is advisable learn about Medicare protection from COVID-19 | life

As the number of COVID-19 (also known as coronavirus) infections increases this winter, older adults and people with disabilities should be reminded of the benefits Medicare covers related to COVID-19 and how to access care.

The COVID-19 Public Health Emergency (PHE) has created various Medicare exemptions and flexibilities that are likely to end sometime next year.

Generally, Medicare covers medically necessary items and services that a beneficiary receives from a provider that accepts Original Medicare or is affiliated with the beneficiary’s Medicare Advantage plan. Medicare Advantage plans must cover everything that Original Medicare does, but they can do so with varying costs and limitations. Let’s take an in-depth look at the COVID-19 Medicare covered services.

Medicare covers COVID-19 testing.

• You pay nothing for a COVID-19 test if you receive it from a laboratory, pharmacy, doctor or hospital and if it is ordered by a doctor or other authorized healthcare professional. Medicare Part B covers this test for free whether you are enrolled in Original Medicare or a Medicare Advantage plan.

•Any US household can order four free at-home COVID-19 tests from COVIDtests.gov or by calling 1-800-232-0233. The tests come in the mail. Accessible tests for people with visual impairments are also available.

•Medicare covers up to 8 rapid home tests per month per participant. Individuals on Medicare Part B can obtain the over-the-counter tests at any participating pharmacy or healthcare provider at no cost for the remainder of the public health emergency.

Medicare covers COVID-19 vaccines.

•Original Medicare Part B covers the COVID-19 vaccine whether you have Original Medicare or a Medicare Advantage plan. You pay nothing for the vaccine and its administration.

•If you receive a COVID-19 vaccine, you cannot be billed for doctor visits or other fees if the vaccine is the only medical service you receive.

•Medicare will provide you with a COVID-19 vaccine at no cost. You can get a booster shot with the same COVID-19 vaccine you originally received or choose a different one.

• Bring your red, white, and blue Medicare card to your vaccination appointment, even if you have a Medicare Advantage plan.

Medicare covers COVID-19 treatments with monoclonal antibodies.

•If you test positive for COVID-19, monoclonal antibody infusion treatments can help fight the disease and keep you out of the hospital.

•Medicare Part B covers monoclonal antibody treatment for COVID-19 if you are enrolled in Original Medicare or a Medicare Advantage plan.

• You pay nothing for treatment during the COVID-19 public health emergency if you receive treatment from a Medicare provider or supplier.

Medicare covers telemedicine services.

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•A telemedicine service is a full visit to your doctor using video technology. During the public health emergency, Medicare Part B covers visits to hospitals and doctor’s offices, counseling, health screenings, and other visits via telemedicine for anyone on Medicare. You can receive these services at home or in health care facilities. You pay 20% of the services provided by your doctor or other healthcare provider and the Part B deductible applies.

•Medicare Part B covers virtual check-ins, also called short visits. You pay 20% of the Medicare-approved amount and the Part B deductible applies. You may not have any costs if you are enrolled in a Medicare Advantage plan.

•Medicare has temporarily expanded its coverage of telehealth services to allow you to interact with nurses, clinical psychologists, licensed clinical social workers and your physicians.

Access your prescriptions during COVID

Contact your Part D or Medicare Advantage plan if you’re having trouble refilling your prescriptions because of the COVID-19 emergency. Your plan may take specific steps to ensure you have access to a pharmacy and are covered by Medicare during the COVID-19 emergency. Some of these actions include:

• Relax restrictions on extended daily supplies and replenish restrictions early when circumstances are expected to affect access to medicines. Check with your pharmacist or Part D plan to see if you can get extended care.

•All Medicare Advantage and Part D plans must cover up to a 90-day supply of a drug if you ask for it. Certain medications with limited quantities that can be safely provided, such as B. Opioids, cannot be filled with a 90-day supply.

•Part D plans must ensure that their enrollments have reasonable access to covered Part D medications at off-network pharmacies when enrollers cannot reasonably expect to use on-network pharmacies.

•Part D plans may waive prior authorization requirements for drugs used to treat or prevent COVID-19.

Changes in Medicare coverage rules.

Due to a national emergency being declared due to the coronavirus outbreak, Medicare may make the following changes to coverage rules:

• Part A Qualified Nursing Facility Coverage – the 3-day hospitalization requirement has been waived even when the care is not directly related to COVID-19

•Home Health Services – Allowing nurses, clinical nurse specialists and medical assistants to prescribe home health services during this public emergency. Previously, only doctors could prescribe home care.

A final word on COVID coverage with Medicare Advantage: Medicare covers all medically necessary hospitalizations, whether you have an Original Medicare or a Medicare Advantage plan. Medicare allows these plans to waive cost-sharing for COVID-19 lab breaks. Many tariffs offer telemedicine advantages in addition to those described above. Check with your plan for coverage and costs.

During the COVID-19 emergency, Medicare Advantage plans are required to cover services at off-network Medicare participating facilities. Participants impacted by the COVID-19 crisis who are being cared for in off-network facilities will not pay more than if they had been cared for in an on-network facility.

(Joel Mekler is a Certified Senior Advisor. Send your Medicare questions to him at [email protected])