Question: How does Medicare cover me if I get sick from COVID-19?

It feels like COVID-19 has changed our daily lives so quickly in so many ways. It is my hope that you are staying safe, which means isolating yourself from physical contact with people outside those that you live with. This does not mean being isolated completely. You can still call people on the phone. Talk to your neighbors while outside and standing apart from one another. Also using FaceTime, Skype and similar tools to see those you cannot see personally.

Original Medicare gives you excellent Health Insurance all the time. Original Medicare allows you to go to any doctor, any lab, and any hospital without prior permission or referral. When thinking about COVID-19, this coverage is excellent and useful.

Centers for Medicare & Medicaid Services (CMS) has worked hard to get in front of this situation. There are some changes that will help you as this situation progresses.

CMS has waived all deductibles and cost sharing under Original Medicare and Medicare Advantage Plans for any laboratory tests and related provider visits as they relate to COVID-19 testing, diagnosis and treatment.

CMS has increased coverage for Telehealth Benefits. The Telehealth Benefit allows you and your physician to use Video Technology to complete office visits, mental health counseling, preventive health screenings and other visits. These visits can take place from your home, or in a health care setting, like adult home or skilled nursing facility.

This Telehealth Benefit would have the same cost share as a typical visit. In other words, this Telehealth Benefit is not covered in full through Medicare or Medicare Advantage Plans. If a physician office visit would cost $40, this Telehealth visit would cost $40.

CMS has also expanded the prescription drug coverage you usually receive through your part D coverage. Prescription Drug Plans typically allow you to refill your medication when you are down to less than 7 days of medication, sometimes as low as 3 day supply. This expanded coverage means you can now refill your medication sooner. You don’t have to wait until you are almost out of medication to get your prescriptions refilled.

This expanded prescription drug coverage also allows you to fill a larger amount. So you can ask to refill the maximum supply allowed. So you may be allowed to get a 90-day supply of most medications instead of the usual 30-day supply you receive. This increased supply of medication will of course cost more as you are getting a 3 months’ supply.

This new expanded coverage allows you to refill your medications earlier and get more of your medication, so that you can reduce the number of times you need to go to the pharmacy to pick them up.

These COVID-19 changes are designed to reduce your exposure to this disease. The more you social distance from others in your community, the less likely you are to get sick from this virus.

For those individuals with Medicare Advantage Plans, there are changes for you as well. For treatment or diagnosis of COVID-19 you are allowed to receive health care services at providers (doctors, labs, & hospitals) that are usually considered out of network. When you use those providers the Medicare Advantage Plan must charge you the same amount they would charge for in-network services. Referral Requirements are waived.

Medicare Advantage Plans must also allow you to receive the maximum supply of your refill medications if you request it.

As we adjust to this new world under COVID-19, we will be hearing of changes and adjustments regularly. It is important to stay informed, but that does NOT mean watch the news all day. This 24 hour news cycle creates anxiety and unnecessary panic.

If you are curious about Medicare coverage, or COVID-19 related issues, go to the source. Call 1-800-medicare, or the website at www.medicare.gov. For information on COVID-19, go to the www.cdc.gov website.

Senior Life Matters is a community based program sponsored by Lutheran Jamestown. For questions and concerns or to reach Janell Sluga, GCMC, call us at 716-720-9797 or e-mail at SLM@lutheran-jamestown.org.