The Centers for Medicare & Medicaid Services (CMS) is taking further action to ensure patients have access to the critical healthcare services they need in the wake of the 2019 Novel Coronavirus (COVID-19) outbreak. Following a meeting with President Trump and Vice President Pence, many leading insurance companies and their industry associations announced they will be treating COVID-19 diagnostic tests as covered benefits and will be waiving cost sharing that would otherwise apply to the test. The President also directed CMS to provide more flexibility to Medicare Advantage and Part D plans to ensure they have the tools they need to provide seniors with the best coverage. As a result, CMS published a memorandum to Medicare Advantage (MA) and Part D health and prescription drug plans informing them of the flexibilities they have to provide healthcare coverage to Medicare beneficiaries for COVID-19 testing, treatments, and prevention.
CMS outlines the flexibilities MA and Part D plans have to waive certain requirements to help prevent the spread of COVID-19. These flexibilities include:
- Waiving cost-sharing for COVID-19 tests
- Waiving cost-sharing for COVID-19 treatments in doctor’s offices or emergency rooms and services delivered via telehealth
- Removing prior authorizations requirements
- Waiving prescription refill limits
- Relaxing restrictions on home or mail delivery of prescription drugs
- Expanding access to certain telehealth services
The U.S. Centers for Medicare & Medicaid Services posted the following to Medicare.gov regarding testing for coronavirus:
Medicare Part B (Medical Insurance) covers a test to see if you have coronavirus (officially called 2019-novel coronavirus or COVID-19). This test is covered when your doctor or other health care provider orders it, if you got the test on or after February 4, 2020. Your provider will need to wait until after April 1, 2020 to be able to submit a claim to Medicare for this test.