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7 Things to Tell Your Clients About COVID-19 and Medicare

Seven Things to Know About COVID-19 and Medicare

Now seven months into the pandemic, coronavirus cases continue to rise across the country. As a result, 60 million Americans on Medicare are more vulnerable every day. Yet brokers can build trust and confidence with clients by sharing the following seven things during this unprecedented period.

 

Background: COVID-19 and Medicare

More than 60 million people are covered by Medicare. Unfortunately, the connection between older age and coronavirus risk presents heightened dangers for Medicare participants.

According to the CDC, “[a]mong adults, the risk for severe illness from COVID-19 increases with age.” Older adults in their 60s and 70s are at higher risk than those in their 50s, but those aged 85 and older face the greatest danger. 

Currently, there is no cure for COVID-19 beyond treating the symptoms of the disease. With that in mind, Medicare participants do have a number of options available to them for testing and treatment.

 

7 Things to Tell Your Clients About COVID-19 and Medicare

When discussing options with your clients, consider the following seven facts about how Medicare coverage and costs are associated with testing and treatment of COVID-19:

  1. Testing for COVID-19 is Covered Under Medicare Part B: This remains true as long as the test is ordered by a healthcare provider that accepts Medicare and the test was ordered after Feb. 4, 2020. Medicare beneficiaries who are tested for COVID-19 do not have to pay the Part B deductible or any coinsurance for this test.
  2. COVID-19 Inpatient Hospitalization is Covered: Inpatient hospitalization required to treat COVID-19 is covered for all Medicare beneficiaries. However, this remains subject to the Medicare Part A deductible of $1,408 per benefit period in 2020. 
  3. Reduced Cost-Sharing for COVID-19 Test and Treatments: Medicare Advantage Plans have access to the same benefits that waive and reduce cost-sharing for COVID-19 lab tests and treatments. Plans may also waive prior authorization requirements that would apply to services related to COVID-19.
  4. COVID-19 Vaccine Cost Coverage: Once a vaccine is discovered and is available, Medicare will cover the cost for participants. Additionally, all Part D plans will be required to cover the novel coronavirus vaccine if it is classified as a Part D drug. 
  5. Relaxed Requirements for Part D Plans: According to the CARES Act, Part D sponsors must relax certain requirements with regard to limits on extended day supply and “refill-too-soon” restrictions. More detailed information can be found at cms.gov.
  6. Emergency Care at Out-of-Network Facilities: Because COVID-19 was declared a public health emergency, individuals in private Medicare plans who are affected by the emergency may receive care from out-of-network facilities at no higher cost than they would pay for an in-network facility.
  7. Telehealth Services Temporarily Waived: The Coronavirus Preparedness and Response Supplemental Appropriations Act temporarily waived restrictions regarding telehealth services. Beneficiaries in any geographical area can now receive telehealth services and do not have to travel to an “originating site” to get medicare coverage, allowing beneficiaries to remain in their home for visits reimbursed by Medicare.

COVID-19 Return to Work Readiness Checklist

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