We are now a few weeks into the coronavirus pandemic. As we know by now, the people who are most at risk are our senior citizens. Most folks over the age of 65 are covered by Medicare or a Medicare Advantage plan. I have been fielding a lot of phone calls as to what is covered and what is not.
I feel confident telling you that Medicare does cover their recipients for most of what they may need if they unfortunately contract the virus and become ill. Because of the enormity of this disease Medicare has added some extra services and has freed up some of their rules.
Over the last two weeks the number one question I am asked is if testing for the coronavirus is covered by Medicare. If you are insured by traditional Medicare or an Advantage plan and if your physician orders that you should be tested, you are covered under Medicare Part B outpatient services. Medicare has waived co-pay and deductible amounts for the test. This also includes hospital observation.
Another question I have been asked is if Medicare will cover the actual COVID19 disease caused by the virus.
If you are covered under traditional Medicare and you become hospitalized, you will fall under the usual Medicare Part A outline. Under Part A there is a hospital deductible for each stay and then daily co-payments if you are still in the hospital past 60 days.
If you have a supplement plan it will cover the deductible and co-pays after the 60 days. Folks who are covered under a Medicare Advantage plan will expect to pay the daily hospital co-pay which is usually a couple of hundred dollars a day.
The last two weeks I have been preaching the value of a hospital indemnity plan that can be purchased and is very inexpensive that can cover that daily co-pay. Contact your BGA agent if that is a concern.
The concern I have is that there are close to 6 million Medicare enrollees who do not have a supplement plan. If you know anyone who doesn’t have one, you should pass along this information and have them contact us. Another topic that seems to come up in conversations often is vaccines.
People always ask me about the Shingles vaccine and if it is covered. The vaccine is not covered however if you contracted Shingles you would be covered for the medical treatment under your Part B of Medicare. That never made sense to me, but it is what it is.
Medicare Part B does cover the vaccine for the flu, and it has been stated by Medicare services that if a COVID19 vaccination becomes available, it would fall under the coverage of the Part D prescription drug program.
For those of you on Medicare Advantage plans and are concerned about being out of your network. CMS has already advised Advantage plan carriers that they must cover services at out of network facilities that participate in Medicare and will abide by in network rates.
This rule has loosened up because this pandemic falls under when a state of emergency has been declared. Regarding Part D drug plans CMS has also loosened restrictions on carriers if their enrollees have to use preferred pharmacies.
This is not a requirement placed on the Part D carrier so check with you plan before you make any change. Two weeks ago, I wrote a blog on the Telehealth system and how Medicare is abiding by folks contacting their doctor by video or phone in the privacy of their own homes.
Telehealth will be covered under Part B for Traditional Medicare recipients during this crisis. Another important change has been made to this program is as follows. In the past, only folks who had previously seen their doctor within the past three years were able to access them through the Telehealth system.
It has now been waived due to this crisis, you can now utilize and get in contact with your physician if you haven’t been seen in over three years. Another issue has risen with people over the age of 65 who were still covered by their employer but now lost their jobs due to this epidemic.
If you fall into this unfortunate situation you can now apply for your Part B Medicare through a Special Election Period (SEP). This period will be extended to you up to eight months after you lose your coverage through your employer. You will find that your local Social Security will be closed during this crisis, so CMS has requested people start calling the local office to get the process started. You can access these forms online and them mail them in.
These are very difficult times that seem to get worse day by day, but we know this disease will have an ending. We just need to be patient and follow the rules of limiting social contact. BGA agents are still working and servicing their clients by phone and online, so if you have any concerns or questions reach out to us, we’re still here.
Be well everyone.