With experts insisting on the critical importance of widespread testing in the struggle to overcome the coronavirus, many are wondering if Medicare will cover the costs. The short answer is: yes. But testing is only the start of where healthcare coverage plays a crucial role in combating the COVID-19 pandemic. Knowing this, Medicare has updated their policy to assist those affected in attaining the care they need. Below we explain the changes, and suggest steps you should take right now to protect yourself from potentially crippling costs.
First: testing.
The Department of Health and Human Services has designated the test for the new strain of coronavirus—officially, COVID-19—an essential health benefit. This means Medicare will cover testing of beneficiaries suspected of having the virus so long as the test is ordered by a physician.
Great! But are physician visits covered?
Yes, Medicare will cover all costs associated with testing including visits to a doctor and hospital observation.
What if I test positive?
If you end up sick with the virus and require outpatient services, Part B of the Medicare plan has you covered. Should you require hospitalization, Part A rules will apply, meaning a $1,408 co-pay per stay and daily co-payments for stays exceeding 60 days. These costs are covered by most supplemental insurance policies.
And if I require post-hospital care?
In the present crisis, Medicare has extended its coverage of care at a skilled nursing facility beyond the normal 100 days after qualifying hospitalizations. Patients will now be covered should they require transfer to a skilled nursing facility in order to make space at hospitals or for any other COVID-19-related reason. For most enrollees, 20 days will be covered after which a $176 co-pay kicks in. Again, most supplemental plans will bridge this cost.
How about network restrictions?
Due to the state of emergency, the Center for Medicare and Medicaid (C.M.S.) requires that participating plans cover out-of-network services at the same rate as they would in-network services. Drug plans have likewise been encouraged to ease restrictions on preferred pharmacy networks but have not been required to do so. To be sure you can get your prescriptions safely and efficiently, check with your plan about updated pharmacy guidelines
Is Telehealth covered?
Yes, throughout the crisis, Telehealth will be covered under Part B for all traditional Medicare enrollees. Care will not be limited to COVID-19-related issues and the requirement that Telehealth be provided by a doctor who has seen the patient within the last three years has been waived.
Can I stock up on prescriptions?
Again, yes. You can and you should. The C.D.C. recommends that you have three-months of prescriptions at home throughout the crisis and, in support of this recommendation, drug plans will be required to provide up to 90-days of covered drugs to those who request them.
I have a question that wasn’t answered in this article…
Of course, here, space only permits coverage of the basics. For more extensive information, take a look at the Kaiser Family Foundation’s excellent F.A.Q. page for Medicare-related coronavirus concerns.
What about Medicaid? Have their policies been updated?
In short, yes, but the specifics vary from state to state. Your best source for comprehensive information is Medicaid’s own website or discussing the policy with an elder law attorney. If you are struggling to find answers to individual questions, don’t hesitate to reach to our office. We are open and operating on an appointment-only basis, as well as offering virtual consultations to better protect our clientele.
In times of trouble, planning is your best defense; however, with the density of information out there, doing so is easier said than done. Knowing this, we’ve compiled a free guide to Medicaid Planning and would be happy to speak with you about details. Feel free to give us a call—we’d love to chat (from a safe distance).
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