Advice for Medicare Beneficiaries, Especially Those New to the Program

COVID-19 has fundamentally changed healthcare for the foreseeable future. And in the wake of this sudden public health event, Medicare, a public health program for over 60 million people, had to adapt some of its policies to incorporate provisions for COVID-19, including lifted restrictions. In the wake of COVID-19 care, it is important that beneficiaries and those newly eligible know what has changed and what their Medicare plan covers. The annual enrollment period ends about two weeks from today on December 7.

Here are some changes to the Medicare program that beneficiaries should know about:

Telehealth

One of the largest adjustments to Medicare plans during the pandemic has been the lifted restrictions for telehealth services. Previously, beneficiaries could only use telehealth if they were in a rural area and visited a location equipped with the service. Now, those restrictions are waived for at least the duration of the public health emergency. Seniors can now hold a telehealth visit from their own homes, assuming they have the right technology to do so. It is also important to note, these telehealth services are not limited to just visits regarding COVID-19. Beneficiaries can also have regular doctors’ office visits, behavioral health services such as counseling, chronic condition management check-ins and more.

Waived Fees

Individual health plans and carriers vary widely on waiving of fees and easement of restrictions. However, the common thread is copays being waived to see the doctor for COVID symptoms, along with copays and lab fees for COVID-19 testing. Medicare is also covering the FDA-authorized serology tests to those who were previously diagnosed with COVID-19, or suspected to have had it, to determine if they developed antibodies to the virus.

Hospitalizations

The cost of hospitalizations varies plan-to-plan. In general, the cost of hospital stays has not changed, regardless if the patient was there for a COVID-19 stay. Medicare Part A covers in-patient hospital and skilled nursing facility stays, some home health visits and hospice care. Part B covers some doctors’ visits, transportation via ambulance and emergency room visits. Therefore, while Medicare will cover medically necessary hospitalizations for COVID-19, patients will still be responsible for hospital deductibles, copays or coinsurance that apply, even if the hospital stay was longer due to quarantine.

One thing to note, Medicare Advantage plans are also required to cover all services found under Original Medicare, including testing, copays, and so on.

What seniors should know

When a safe and effective vaccine is distributed nationwide, it will likely be covered by most Medicare plans, as preventive care is covered under the ACA. However, there have been cases in the past where a vaccine costs the same copay as a Tier 1 generic drug. Tier 1 drugs are usually the lowest cost option, which would likely be automatically approved by a plan.

Michael Howard is Medicare licensed insurance agent for GoHealth.