Medicare coverage and the response to the Coronavirus

Early Saturday, March 14, the House passed legislation (R. 6201) that would waive all beneficiary cost sharing for coronavirus testing and the associated doctor’s office visit. 

The Centers for Medicare & Medicaid Services (CMS) is working to address the spread of the disease and inform people with Medicare about the services that Medicare covers. The Centers for Disease Control and Prevention (CDC) has identified : at a higher risk.

  • older adults
  • people with serious chronic medical conditions
  • heart disease
  • diabetes
  • lung disease

Coverage access during public health emergency

Medicare Advantage Plans and Part D plans usually have networks of providers and pharmacies that beneficiaries must use in order to receive covered services at the lowest cost.

During emergencies, Medicare Advantage Plans must work to maintain access to health care services and prescription drugs for plan members living in affected areas. Plans must meet certain requirements following the declaration of a disaster, emergency, or public health emergency.

At this time, Medicare has also given plans the flexibility to make optional changes to their cost-sharing and coverage. These optional changes include:

  • Charge $0 cost-sharing for COVID-19 tests
  • Charge $0 cost-sharing for COVID-19 treatments in doctor’s offices or emergency rooms and services delivered via telehealth
  • Remove prior authorizations requirements
  • Expand access to certain telehealth services
  • Remove prescription refill limits
  • Relax restrictions on home or mail delivery of prescription drugs

Every Medicare Advantage and Part D plan is different. Beneficiaries should contact their plan directly to learn about how it covers services related to coronavirus.

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