Updated: May 28, 2020
By Gary Floring, We Speak Medicare
The novel coronavirus (COVID-19) has disproportionately affected senior citizens, especially those over 70.
The following Q & A's provide the latest information on how Medicare recipients can expect to cover any cost associated with COVID-19, such as testing, treatment, hospitalization, etc.
As of May 2020, there is no vaccine against this global pandemic. If you only have Original Medicare (Parts A and B) and have to be hospitalized due to COVID-19, you may still be liable for the Part A deductible, which is $1,408 per hospital visit in 2020.
What if I need to be tested for COVID-19?
Under the recently passed Families First Coronavirus Response Act, deductibles and copays for people on Original Medicare and who have Medicare Advantage plans (Part C) will be waived for medical services related to COVID-19, such as going to the doctor or hospital emergency room to see if they need to be examined. If you are not hospitalized but have symptoms of COVID-19, Medicare even allows your doctor to order a test to be administered to you at home by a certified health professional, at no cost to you.
What if I am hospitalized for another reason and then contract COVID-19?
You will not pay any additional copays or deductibles even if you might have otherwise been discharged from the hospital after an inpatient stay for another, unrelated reason. Likewise, you will not have any additional out-of-pocket costs if you are required to stay in the hospital under quarantine in a private room.
Will the cost of vaccination be covered?
Biogenetic engineers and scientists around the world are intensely studying COVID-19 to develop a vaccine, which is not expected until sometime in mid-2021. Original Medicare or your Medicare Part D plan will cover the cost of a vaccine once it becomes available.
How will my prescription medications be affected by COVID-19?
Due to coronavirus, Medicare Part D and Medicare Advantage plans are now allowed to loosen rules on early prescription refills. These rules can be relaxed if you are facing a hardship in obtaining medications due to the crisis. However, it's up to the discretion of each plan as to how they loosen the rules. Other rules that may be relaxed are reimbursements for prescriptions you buy at an out-of-network pharmacy, by mail, or home delivery services. Please check with your Part D or Medicare Advantage plan, or your pharmacy about allowances for early refills.
What kind of services are available from home?
Medicare has temporarily expanded its coverage of telehealth services to respond to the COVID-19 crisis. These services expand current telehealth covered services, to help you have access from more places with a wider range of tools (phone calls, text messages, e-mail, audio and video interface) to communicate with providers such as doctors, nurse practitioners, clinical psychologists, and licensed social workers. During this time, you will be able to receive a specific set of services through telehealth including evaluation and “virtual office visits” from home, mental health counseling, and preventive health screenings, all without a copay under Medicare. The intent is to allow Medicare recipients to avoid traveling to doctors’ offices and other health care facilities to minimize exposure to COVID-19, with no out of pocket expenses.
What if I don’t have a Medicare Advantage plan but am covered instead by a Medigap plan?
Seniors who have Medicare Supplement (Medigap) plans through private insurance carriers may have access to the same benefits outlined above. Medicare is encouraging Medicare Supplement insurance carriers to waive cost-sharing for COVID-19 lab tests. Many of their plans offer additional telehealth benefits, so make sure to check your individual plan to determine what is covered, what may be excluded and any associated out-of-pocket costs. Major Medicare Supplement carriers have already announced various allowances and/or waivers due to COVID-19. Again, check your individual Medicare Supplement plan for specific details.
Can I still apply for Medicare during the COVID-19 crisis?
Yes, but most Social Security offices are closed or on reduced hours. Therefore, if you are turning 65 or are under 65 and have a disability, you must go to ssa.gov and apply for Medicare. If you are 65 or older and have lost your job and health insurance, or were on your spouse's health insurance but they lost their job and health coverage, you can go to the SSA website and apply for Medicare by requesting a Special Enrollment Period (SEP).
Normally, if you are applying for Medicare Part B as part of the SEP, your employer or your spouse’s employer would have to attest that you had health coverage within the past eight months. Medicare has waived that requirement now, by allowing applicants to apply individually, but you must still submit proof that you previously had health coverage. The application consists of two forms, Medicare Part B form CMS-40B and CMS L564- Request for Employment Information. These two forms, along with proof that you previously had health coverage, can be faxed to 833-914-2016. If approved, your coverage for Medicare Part B becomes effective the following month after your application date.
What if I had scheduled elective surgeries before the crisis?
Medicare has requested doctors and their patients to postpone elective surgeries and other procedures because COVID-19 cases are straining medical facilities at least through June. So while elective surgeries are not prohibited, it is strongly recommended that you wait until the crisis is over.
What should I do if I have additional questions about Medicare and COVID-19?
The Medicare hotline is available 24 hours a day, seven days a week at 800-MEDICARE. Please remember that the current crisis may cause long waiting times. You should also visit www.medicare.gov for the latest information. For Washington-specific information, go to www.insurance.wa.gov/medicare-and-coronavirus. For Medicare Advantage or Medicare Supplement plan-specific details, please contact your insurance carrier or agent.
Article Compiled by:
Gary Floring, We Speak Medicare
Serving Clallam & Jefferson Counties