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Medicare Coverage COVID-19

Please be aware that information surrounding COVID-19 are moving very rapidly. While all the information in this article are correct at the time of submission things may have changed by the time it appears.

Temporary Waivers of Medicare Rules. Most of the changes in Medicare rules are taking place under what are called waivers, that is, temporary changes in the rules. Some of the waivers that have been granted include:

The expanded recruitment of providers. This waiver allows providers, physicians and nurses in particular, licensed in one state to practice in another state. This was the waiver that allowed a number of health care professionals to travel to New York City to assist hospitals when they became overwhelmed during the peak infection period.

Increased flexibility to hospitals, nursing homes and other facilities. One example of this flexibility is allowing hospitals to create temporary beds in make-shift spaces outside their licensed physical facility. Another example would be allowing nursing homes to create separate, special segregated COVID-19 units in order to quarantine their residents who have tested positive for the virus.

The suspension of some reporting and oversight requirements. Some suspension of reporting requirements was done to free up staff and to allow them to focus on reporting COVID-19 data. Standard reports will still need to be submitted at a later date.

Expansion of Telehealth. Of all the temporary waivers, the one that may have the greatest impact is the expansion of Telehealth.

Telehealth visits can now be used by doctors, nurse practitioners, clinical psychologists and licensed clinical social workers. As a general rule, Medicare will cover routine primary care visits, mental health counseling, preventive health screenings for cancer and other illnesses using Telehealth.

It appears that for this coverage to apply, the service will need to be delivered using both audio and video with a chat function. Cost-sharing for Telehealth visits can be charged, but the waiver says that providers will not be subjected to any sanctions for either reducing or eliminating cost-sharing entirely.

Medicare Payments for COVID-19 Testing and Treatment. Medicare will pay for virus testing with no cost sharing. When a vaccine becomes available it will be covered in full by all Part D plans. Finally, cost-sharing can apply to COVID-19 treatment. Following the Centers for Medicare and Medicaid Services (CMS) guidelines, Medicare Advantage plans may waive cost-sharing for COVID-19 treatments received in either your physician’s office or in a hospital emergency department.

Changes in Medicare Advantage Plan Rules. CMS is relaxing some of the rules for Medicare Advantage (MA) Plans. For example, MA Plans are now allowed to make mid-year adjustments to expand their benefit packages to address the COVID-19 outbreak.

CMS states that plans “may implement additional or expanded benefits that address issues or medical needs raised by the COVID-19 outbreak…“

Plans may also institute “more generous cost-sharing” as long as the changes are provided uniformly to all similar enrollees. If you are treated for COVID-19 MA Plans must cover the costs if you are treated in a non-network or contracted facility so long as the facility accepts Medicare. This change became necessary as COVID-19 patients are placed in facilities on a “space available” basis.

Hospital Charges. If you are treated for COVID-19 Medicare will waive the differential charge for a private room if it is medically necessary. Also, in order to set-up sufficient testing locations, hospitals will be allowed to perform covered tests for COVID-19 in other community-based setting and temporary locations. Tests can also be preformed by hospitals in the Medicare recipient’s home.

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