March 28, 2020
Given that many older Americans are at high risk for serious illness from the coronavirus, certain rules have been relaxed as a result to help Medicare beneficiaries manage throughout the crisis. It’s also an important time to pay close attention for scammers and elder fraud.
Testing and Outpatient Services
Tests for the Coronavirus are covered under Medicare Part B (for both traditional Medicare and Medicare Advantage plans) and the co-pays and deductibles for a test any associated services for physician visits and hospital observation have been waived.
The Centers for Medicare and Medicaid (CMS) has advised Medicare Advantage plans that, during the crisis, they must cover out-of-network services at no more than in-network rates for services provided at any out-of-network facilities that participate in Medicare. The purpose of this provision is to limit how far folks may have to travel to receive care.
Also in an effort to keep folks at home, Telehealth provisions have been relaxed to support containment efforts for both patients and care providers. Telehealth coverage, which had been tightly restricted, will be covered under Part B for all traditional Medicare beneficiaries during the crisis and not limited to COVID-9 care. You can now connect from home, via video on a smartphone or other digital device, as opposed to having to connect from an outpatient center. The requirement that Telehealth be provided only by a doctor who you’ve seen in the past three years has also been waived. Medicare Advantage plans have their own rules so it’s important to check on this issue with your plan provider.
If you require hospitalization, then this will be covered under the usual Medicare Part A rules for per day deductibles and co-payments. If you are initially treated at or transferred to a skilled nursing facility in order to make room at the hospital, then you will still be covered.
Vaccines and Prescriptions
If a vaccine becomes available, it will be covered through Medicare Part B under a provision included in the CARES Act approved on March 27, 2020.
In contrast to the need to limit how far folks have to travel during the crisis, existing drug plans often require enrollees to use preferred retail or mail-order pharmacy networks. The CMS is permitting plans to relax these rules, but it’s not a requirement so make sure to check with your plan.
Importantly, the CARES Act requires plans to issue up to a 90-day supply of covered drugs to enrollees who request it during the crisis.
No changes have been made to the Medicare enrollment process. If you are 65 or older and need to sign up for Medicare now because of a job loss, you have a special enrollment period that lasts eight months after you lose your employer –sponsored health insurance coverage. This decision includes either enrolling in traditional Medicare (Parts A, B & D and a Medicare Supplement Plan) or a Medicare Advantage Plan. There are steep penalties for late enrollment in Part B, so be sure to sign up during this time and be aware that it may be more challenging than usual.
Enrollment is typically handled through your Social Security office, however, these offices were closed last week as a result of the crisis. It’s recommended to call your local office to get the application started (they should be able to tell you what forms you need and where to send them) and to request a “protected filing date” as proof that you applied for benefits. You can also look to apply online through www.ssa.gov/benefits/medicare/ .
Protecting your Loved Ones
It’s more important than ever to look after those who are isolated or lonely. Scammers will take advantage of the current crisis for identity theft and other Medicare fraud schemes. You’ve likely seen stories of nonexistent vaccines being touted on TV, but the risk also includes email, telemarketing, social media and even door-to-door visits.
Enrollees should only provide the Medicare number to participating doctors, pharmacists or those you trust to work with Medicare on their behalf. You can review steps to avoid elderly financial fraud and why older Americans are susceptible to financial fraud here. And you can find additional Medicare resources on protecting your identity here and fighting fraud here. If you suspect fraud, call 1-800-MEDICARE.
Given that older Americans are at high risk during the crisis, Medicare advocates will continue to propose further changes to expand coverage and lower costs during the crisis and perhaps permanently. We will continue to update our clients as any new information becomes available.
For additional information on CARES Act provisions the apply to individuals, please review our separate commentary posted today. And, if you have any questions, please reach out to your ACM Wealth Advisor.