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CMS & Insurers Announce Part C and D COVID-19 Coverage

CMS & Insurers Announce Part C and D COVID-19 Coverage

News about the coronavirus — officially called the SARS-CoV02, 2019 Novel Coronavirus, or COVID-19 — has been everywhere lately. As of writing this article (March 12, 2020), there are more than 124,000 cases confirmed worldwide and more than 4,600 deaths. The potential strain this may put on the health care system in the United States, and around the world, further exacerbates fears about a possible response. Furthermore, there are concerns about testing and treatment potentially financially-crippling many Americans. Luckily, the health care system and Centers for Medicare & Medicaid Services (CMS) have begun to rise to the challenge.

After meetings with the Executive Branch, a number of the leading insurance companies, and industry associations, CMS announced a guidance measure to help Medicare enrollees receive assistance with services involved with COVID-19. This guidance, and the memorandum issued along with it, aims to help contain and control the COVID-19 outbreak in the United States.

CMS’s Announcement

The guidance issued by CMS on March 10 announced several flexible waiving options for Medicare Advantage and Part D plans to promote access to healthcare services related to the COVID-19 outbreak in the United States. The main announcement, which came out of the meetings that led to this guidance, regarded how Medicare Advantage and Part D plans would consider COVID-19 diagnostic tests as covered benefits. Part of this means that cost-sharing that would usually be a part of the test would be waived.

Today we announced guidance to Medicare Advantage and Part D plans to remove barriers that could prevent or delay beneficiaries from receiving care. Medicare beneficiaries are at the greatest risk of serious illness due to COVID-19 and CMS will continue doing everything in our power to protect them. — Seema Verma, CMS Administrator

Waiving the cost-sharing associated with the diagnostic test wasn’t the only announcement to come out of the meeting. Along with the guidance, CMS issued a memorandum to outline suggested services and items to waive cost-sharing on. These suggested flexibilities include:

  • Waiving cost-sharing for COVID-19 tests
  • Waiving the cost-sharing for COVID-19 treatments in doctor’s offices or emergency rooms
  • Waiving the cost-sharing for COVID-19 treatments via telehealth
  • Expanding access to specific telehealth services
  • Waiving prescription refill limits
  • Relaxing restrictions on home or mail delivery drugs
  • Removing prior authorization requirements

The goal of these flexibilities is to remove as many barriers as possible and encourage Medicare beneficiaries to receive proper testing and treatment. Knowing that, if you’re enrolled in Medicare and feel like you may have COVID-19 (see below for symptoms), please see your doctor to get tested and self-isolate, so you don’t spread any potential illness you may have.

Just How Bad is COVID-19?

With how serious COVID-19 is being treated, is it as bad as many people think? In truth, right now it’s mixed. So far, more than 4,600 people have died, giving it a fatality rate of roughly 3.4 percent according to the World Health Organization. This makes it more deadly than the seasonal flu, which has a global mortality rate of less than one percent. But, we also don’t want to be fearmongers. Estimates of the fatality rate outside of Wuhan, China (the epicenter of the outbreak) is thought to be .7 percent. The rates may even be lower than this since in many cases, the symptoms are so mild that they may not be aware they’re even sick or decide to seek medical help. Comparatively, the 2003 SARS outbreak had a fatality rate of 9.6 percent overall and the plague that ripped through Eurasia was between one and 40 percent for individuals who receive treatment (50 to 100 percent if they were untreated). And, despite having a lower fatality rate, seasonal flu is estimated to have killed nearly six to 15 times the number of people in the United States alone (seriously, get your flu shot).

While people of all ages are catching COVID-19, the demographics hit the hardest are seniors; those with chronic illnesses or weakened immune systems. If you’re enrolled in Medicare, you likely fall into one of those categories. Even though the estimate of the fatality rate for COVID-19 is between .7 and 3.4 percent, the estimate for seniors stands at eight and 14.8 percent. This makes CMS’s guidance all the more important. Getting tested will help slow or prevent the spread of coronavirus by identifying cases early. By waiving fees — among other aspects of these benefit changes — CMS is helping to expand the availability of COVID-19 services and promotes greater flexibility for insurers to offer more coverage. This grows in significance when you consider the elderly and chronically ill more likely to die or have a severe case of COVID-19. What this all means is that you should take COVID-19 seriously, especially if you’re in the risk populations. To learn more, check out the Centers for Disease Control and Prevention (CDC) central COVID-19 website.

COVID-19 Symptoms

  • Fever
  • Cough
  • Shortness of breath
  • Symptoms may appear 2-14 days after exposure

Source

Further Reading

Medicareful Living — Ways to Avoid Getting Sick