Individuals awarded Social Security Disability Insurance (SSDI) are entitled to Medicare two years after receiving SSDI benefits. In 2018, over 8.2 million people on SSDI were covered by Medicare. Many SSDI/Medicare beneficiaries have questions about how Medicare will cover care for coronavirus related health issues. The Centers for Medicare and Medicaid Services (CMS) has responded to the current crisis by offering free coronavirus testing and testing-related visits. For those with a Medicare Part D prescription drug plan, or drug coverage through a Medicare Advantage plan, Medicare has relaxed certain rules to offer more services, including 1) filling prescriptions early, if needed; 2) free local delivery of medications; and 3) converting to mail-order or a 90-day home delivery supply, if available. Below is a summary of how Medicare will expand health coverage to beneficiaries impacted by coronavirus.
Testing: Coronavirus tests approved by your health care provider are covered by Medicare, free of charge. Any co-pays or deductibles have been waived, including test-related services from a physician, outpatient facility or hospital.
Outpatient services and hospital care: These services are covered under Medicare Parts A and B, and the Medicare deductible rules still apply. If you have a Medicare Supplement or Advantage plan, check with your plan to find out specific deductible amounts. With some plans, there are no deductibles for outpatient or hospital services.
Skilled nursing: Medicare has waived certain hospitalization requirements for skilled nursing coverage. During the coronavirus crisis, Medicare Part A will cover skilled nursing facility stays of up to 100 days (with certain deductibles), whether or not patients enter the facility after discharge from an inpatient hospital stay. Check with your Medicare Supplement or Advantage plan to see what deductibles apply to skilled nursing stays.
Vaccinations: If and when a vaccine is available for Covid-19, Medicare Part B will cover it free of charge under the new Federal Coronavirus Relief Act (CARES).
Out-of-network health providers: If you are enrolled in a Medicare Advantage or Part D drug plan, check with your plan regarding use of out-of-network providers or pharmacies during this health crisis. Those subject to a stay in place order, the elderly, and people with preexisting conditions more vulnerable to coronavirus, may not be able to travel to their primary care physician or preferred pharmacy. CMS has instructed Medicare Advantage and Part D plans to cover out-of-network services and medications at the same cost as in-network providers or pharmacies during this emergency.
Prescription drugs: Check with your Medicare Advantage or Part D Drug plan if you need a prescription filled early, are interested in home delivery options, or would like to convert to 90-day mail order supply of your medications. CMS is allowing Medicare drug plans to relax their policies regarding preferred pharmacy networks and home delivery services.
Telehealth services: Medicare beneficiaries will have expanded telehealth benefits to connect with their health care providers remotely during the coronavirus crisis, including health matters unrelated to Covid-19 care. Patients can call their providers using a smartphone or other digital device at home. Check with your health provider and/or Medicare plan regarding what telehealth services are available.
For more information: The CMS website has updates about how Medicare has expanded its benefits to address the coronavirus: https://www.medicare.gov/medicare-coronavirus#600
If you have any questions about your Medicare coverage, please contact our offices. We are here to address your concerns at this challenging time.
