The coronavirus is an overarching term for a group of viruses that have the capacity to bring on illnesses that range from the common cold to an intractable affliction, such as SARS (severe acute respiratory syndrome), MERS (Middle East respiratory syndrome) and COVID-19 (coronavirus disease 2019). The repercussions of the newly identified coronavirus, SARS-CoV-2, which is the source of the COVID-19 disease, have spread across of the U.S. healthcare system. Experts caution that some segments of the population appear to be more prone to suffering from severe disease than others.

Vulnerable population at higher risk
The CDC (Centers for Disease Control and Prevention) acknowledges that there is a limited amount of data on the risk factors that exacerbate the disease, but based on what has been shared by subject matter experts, “older adults and people of any age who have serious underlying medical conditions might be at higher risk for severe illness from COVID-19.” Since this speaks to Medicare recipients, CMS (Centers for Medicare & Medicaid Services) enacted changes designed to ensure Medicare patients have access to critical healthcare services during these unprecedented times.

Medicare Advantage and prescription drug plans
Many MA plans incorporate Part D, the prescription drug coverage, into their benefits along with Parts A and B. Medicare beneficiaries enrolled in MA-PD (Medicare Advantage with prescription drug coverage) do not need to sign up for Part D separately. Although MA and Part D are offered by private insurance companies, these companies must comply with CMS guidelines in order for the plans they offer to be Medicare-approved. Due to the pandemic, some of these rules have been relaxed.

CMS guidelines
New CMS guidelines disseminated to MA and Part D insurers outline the flexibility these companies now have to expand parameters of certain plan provisions, namely COVID-19 testing, treatment and prevention. The intent is to remove any obstacles that might prevent or postpone healthcare delivery for those with Medicare coverage. This impacts coinsurance, copayments, pre-authorizations and limitations. MA and Part D plans may now:

  • Waive cost-sharing for COVID-19 tests, telehealth services, and treatments in a physician’s office or in an emergency room.
  • Remove mandatory pre-authorizations, and waive limits on prescription refills.
  • Reduce restrictions on the delivery of medication.
  • Widen access to some telehealth services.

Medicare coronavirus-related benefits
According to the official Medicare website, the following coronavirus-related services will now be covered. The same benefits apply to Medicare Advantage plans.

  • Lab tests for COVID-19 with no out-of-pocket costs.
  • FDA-approved COVID-19 antibody tests.
  • All medically needed hospitalizations.
  • COVID-19 vaccine once available.
  • Skilled nursing facility care with certain requirements waived.

For the most current information on Medicare coverage for coronavirus, please visit the official Medicare website.

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