As a result of the COVID-19 pandemic, the Center for Medicare and Medicaid Services (CMS), has used its emergency powers to make temporary changes to Medicare. Some changes may eventually become permanent, but for now, they are affecting current benefits, if you are a Medicare beneficiary.
Coverage and out-of-pocket costs
While COVID-19 coverage and cost changes are a constantly moving target, here are the current significant ones affecting:
Beneficiaries with Original Medicare and Medicare Supplement plans:
- Waiver of the requirement for a three-day hospital stay before Medicare will pay for a stay in a skilled nursing facility (SNF).
Beneficiaries with Medicare Advantage plans:
- Full coverage of benefits and services provided by out-of-network providers, if the providers participate in Medicare.
- Cost-sharing (copays and deductibles) for out-of-network services is at the same rate as for in-network services.
- Waiver of requirements for referrals and prior authorizations for medical services.
All Medicare beneficiaries:
- Waiver of the requirement for “60-days without skilled care” before qualifying for a second 100-day SNF period in certain circumstances related to COVID-19.
- Full coverage of all COVID-19 and related blood tests, including those to determine if you have developed antibodies to the virus. You will not pay a deductible or coinsurance.
- Waiver of the requirement for an order from a medical practitioner to receive a COVID-19 test.
- Coverage for a lab technician to come to your home to collect a specimen for COVID-19 testing, eliminating the need to travel and risk exposure.
- Full coverage for the COVID-19 vaccine, when it’s approved. You will have no costs.
- Removal of some restrictions on coverage for telehealth. See more details below.
Telehealth expansion
Medicare Advantage plans already are allowed to cover telehealth, but it has not been widely implemented. Now, CMS has waived restrictions on Original Medicare’s coverage of telehealth as well, including:
- Waiver of the video requirement if you don’t have access to this technology. You will be able to use an audio-only telephone to receive telehealth services.
- Expansion of the types of specialists allowed to provide telehealth. You can use telehealth services for routine primary care visits as well as to see physical therapists, occupational therapists, speech pathologists, behavioral health providers and patient educators.
Part D drug supply broadened
Upon request, all Part D drug plans are required to provide you with up to a 90-day supply of all medications, without regard to previous limits on quantity or the number of days of supply. The exception is for opioids or similar medications.
Contact us
To understand other or future changes in your coverage for your Everence Medicare Supplement plan, please contact our Member Services staff at 800-348-7464 ext. 2460 or member.services@everence.com.