The outbreak of the coronavirus has brought trying times for all Americans, but particularly for seniors since they are at a higher risk for complications from the virus. Questions regarding coverage have added confusion to the mix. In response, the Centers for Medicare & Medicaid Services (CMS) recently published an FAQ (frequently asked questions) post to provide some answers.
The FAQ’s were posted on March 12, 2020, and can be found here. Additionally, I will try to provide some insights.
The Good News - You’re Covered for Diagnosis and Treatment
Essential Health Benefits (EHB) does currently include coverage for the diagnosis and treatment of COVID-19. Coverage detail may vary by plan, and some plans may require authorization, but at it stands now, “EHB generally includes coverage for the diagnosis and treatment of COVID-19“ according to the post. Additionally, many health plans have announced that they will be waiving any cost-sharing requirements for COVID-19 diagnostic tests, and many states are requesting or requiring that all health plans in their state do the same.
Please note that for non-Medicare health plans, the co-pays for the Coronavirus test have been waived, but not the cost of the doctor visit needed to get the test or the treatment.
You’re Also Covered for Quarantine and Hospitalization
According to the post, “Medically necessary isolation and quarantine required by and under the supervision of a medical provider during a hospital admission are generally covered as EHB.“ Plan vary regarding cost-sharing, and some plans may require pre-authorization, but you’re covered.
Self-quarantine in a home does not require coverage as an EHB, but certain medical benefits involved in the home quarantine may be covered as part of EHB if they are required by and done under supervision of a medical professional.
The Trump administration announced on March 16 that it will expand telehealth services for Medicare beneficiaries and cut back on HIPAA enforcement on a temporary basis in order to combat the pandemic. Medicare will pay for office and hospital telehealth visits and include a wide range of providers including nurse practitioners, clinical psychologists and social workers. Telehealth visits will be reimbursed for the same amount as in-person visits.
Will a COVID-19 Vaccine be Covered?
A coronavirus vaccine is still 12-18 months away from being available, but it will be covered if it’s recommended to be by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC). A health plan is not required to cover the cost of the vaccine until the beginning of the plan year that is 12 months after the recommendation, but many plans may voluntarily provide coverage before the required date. They may also cover the cost sharing portion of the benefit.
Please stay safe and keep your socializing at a distance during these trying times. I am available, so please don’t hesitate to contact me with any questions or concerns that you may have. Rules regarding coverage are subject to change, and I’ll continue to keep you informed.