Medicare in the Time of COVID-19: Here’s What You Need to Know
By Lindsay Engle for the NABBW
It’s been almost a year since the COVID-19 pandemic began, and just as you’ve had to adjust parts of your life to protect yourself and your family, Medicare has also had to modify their coverage.
The goal of this article is to help you, as a Medicare beneficiary, to know what changes and modifications the Centers for Medicare and Medicaid Services (CMS) have made.
Increased Access to Telehealth Services
First and probably most significant, Medicare has temporarily increased coverage for telehealth services. Telehealth includes telemedicine, or remote clinical care. You can now make virtual visits to your doctor in real time through videoconferences services like Zoom. The goal is to as much as possible replicate traditional in-person care.
This isn’t a totally new Medicare service, but an expansion. Prior to the pandemic, Medicare had been trying to help people in rural areas, who are often medically underserved, have access to medical care via telehealth programs.
So when the Coronavirus Aid, Relief and Economic Security (CARES) Act was enacted shortly after the pandemic began, it made sense for CMS to relax HIPAA guidelines for the duration of the pandemic for two reasons:
- People on Medicare tend to be at higher-risk for COVID-19, and
- Telehealth programs eliminate the potential for COVID exposure – such as being in waiting rooms with sick people – which accompanies traditional healthcare settings.
Additionally, CMS now allows remote care across state lines and outside of rural areas. And new patients can utilize telehealth, which had previously only been available to established patients.
Telehealth covers COVID-19 evaluations to determine whether further care is necessary, with practitioners often waiving fees for the service. Other virtual services receiving coverage from Part B include:
- Doctor visits
- Physical and occupational therapy evaluations
- Speech therapy
- Mental health services such as psychotherapy
- Treatment for substance abuse disorders
You’ll also be glad to know the charges for you to use telehealth services are the same as what you’re paying for in-person services, whether the telehealth comes to you via video or is audio-only – the latter being newly available since the pandemic began. In Alaska and Hawaii, Medicare also permits payment for store-and-forward, which is an asynchronous technology.
As always, before you start working with a new healthcare provider, it is important that you check to make sure they accept Medicare assignment.
- If you have an Advantage plan, make sure your providers are in your plan’s network.
- Also be aware that if you have an Advantage plan, you may also have access to additional telehealth benefits beyond what is available through Parts A and B.
- It’s always best to check on this directly with your plan provider.
Virtual check-ins and E-visits – which allow you to talk to your doctor or other practitioners – are also available for established patients during this public health emergency. While they are not technically telehealth services, they do use online patient portals, keeping you out of public places.
- Virtual check-ins are brief – you can handle them by phone or via other devices like secure text messages or email – to find out whether you need further care. And you can check-in from anywhere.
- E-visits, if you’re not familiar with them, take place via an online portal, and also allow you to talk to a healthcare provider without going to the office.
Greater Access to Mental Health Care
As the pandemic has dragged on, we’ve all become aware that it is taking a toll on everyone’s mental health. We know that Medicare beneficiaries are accessing psychology and psychiatry services on a large scale through telehealth. In fact, more than half of those on Medicare who access mental health care do so virtually. Again, this practice reduces the odds of spreading or contracting the virus and provides you with more privacy. We expect some new mental telehealth services, including group psychotherapy, will remain after the pandemic is over.
Medicare Coverage for COVID-19 Testing and Vaccines
Part B, the medical insurance component of Medicare, covers the cost of COVID-19 testing, with no requirement for a physician’s note. So, beneficiaries can go to approved facilities and drive-through testing locations for free. This coverage is also available for specific at-home COVID tests with emergency use authorization and more than 90% accuracy.
Free COVID testing removes all financial barriers that might have otherwise caused people to skip the process. Medicare recommends that you take a COVID-19 test if you have symptoms, have been in close contact with someone who’s tested positive, or if your doctor recommends testing. Additionally, the CDC recommends quarantining while waiting for results.
Medicare Advantage (Part C) plans cover everything that Parts A and B cover, in accordance with requirement. There is no cost-sharing for testing services, per a Families First Coronavirus Response Act provision.
Your Part B coverage also means you won’t pay anything for the FDA-approved preventive COVID-19 vaccines. This outpatient component also covers other preventive vaccines, such as the flu shot.
In addition, Part B covers antibody tests and monoclonal antibody treatments. Antibody tests can tell you if you’ve had a prior COVID-19 infection. Monoclonal antibody treatments are for those with current, mild-to-moderate cases of the virus at a high-risk to progress to severe or require hospitalization.
COVID-19 Treatment on Medicare
If you become critically ill with COVID-19, your Part A (inpatient coverage) pays for inpatient stays at hospitals and skilled nursing facilities. Part A also covers some home health visits and hospice care. When you’re admitted to the hospital for COVID-19 treatment, the Part A deductible of $1,484 applies.
Part B (outpatient coverage) covers COVID-related doctor visits, emergency transportation via ambulance, visits to the emergency room, and infusion drugs administered by physicians. The Part B deductible of $203 applies to most outpatient services.
Supplemental coverage, such as Medigap, can help with costs related to COVID-19 treatment. According to the Kaiser Family Foundation, 19% of those on Medicare lacked supplemental coverage in 2016, accounting for over 6 million people. Advantage plans often waive costs for these treatments, but these plans are not required to do so.
COVID-19 as a Pre-Existing Condition
Will a prior COVID-19 infection fall under the category of pre-existing conditions? There is some speculation that it may, and we all know pre-existing conditions can disqualify someone from enrollment in a health plan. Thankfully this will not be a concern for those with Original Medicare (Parts A and B), since the program covers those with pre-existing conditions.
However, a pre-existing condition could disqualify you from enrolling in a Medigap plan. Thus, it’s wise to utilize your Medicare Supplement Open Enrollment Period – a six-month window beginning with your Part B effective date. This enrollment period offers a chance to bypass health questions so you can enroll in any Medigap plan with any carrier.
Clearly the COVID-19 pandemic has changed the world. We see the importance of mental health care and the the need for the convenience of virtual care is evident. You’ll be glad to hear that CMS is taking note. Medicare will likely continue to expand coverage of both, even after the pandemic is over.
Additionally, most people on Medicare feel comfortable receiving the vaccine and believe that masks should be mandatory. Their caution shows the prioritization of safety at this time. The changes to CMS make prevention and care affordable and accessible, which is why it’s so important for all Medicare beneficiaries to be informed. That’s why I’m closing this article by asking that you please share this information with your family and friends who are on Medicare.
NABBW member Lindsay Engle is the Medicare expert for MedicareFAQ. She has worked in the Medicare industry since 2017, is featured in many publications, and writes Medicare-focused columns for many others. You can also find her on MedicareFAQ’s Medicare Channel on YouTube as well as contributing to their Medicare Community on Facebook