March 23, 2020

Edited 05/19/20

Medicare FAQs During COVID-19 Outbreak

Rhian Horgan, CEO of Kindur and Silvur, hosts Jo Schneier, CEO of Trusty.care. 

Due to the outbreak of COVID-19, many Americans near 65 or over have concerns about their Medicare plans and how this pandemic affects them. Rhian and Jo sit down to discuss all your questions and concerns around Medicare. 

How can I apply for Medicare if the Social Security offices are closed?

  • You can also enroll by calling Social Security at 1-800-772-1213 (TTY users 1-800-325-0778), Monday through Friday, from 7AM to 7PM. 

What information do I need before enrolling in Medicare online?

To enroll online you’ll need to create a mySocialSecurity account if you don’t have one already. To set this up you’ll need your Social Security Number and to answer a few identity questions for verification, so it is a good idea to have a W-2 and other tax documents on hand. You should also have the following information to speed up the process:

  • Date and Place of Birth
  • Permanent Resident Card number (if you are not a U.S citizen)
  • Medicaid Number (if you have one)
  • Current Health Insurance (start and end dates)

Does Medicare cover COVID-19 testing?

  • Medicare Part B covers a test to see if you have 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.
  • A recently-passed law also eliminates beneficiary costs for COVID-19 testing-related services, including the associated physician visit or other outpatient visit (for instance, a hospital observation, E-visit, or emergency department services). 
  • The law also eliminates cost sharing for people on Medicare Advantage, and makes it so you don’t have to get permission from your insurance company (“prior authorization”) before getting the testing and the services.

Does Medicare cover COVID-19 treatment?

  • There is no known treatment for COVID-19 yet beyond treating the symptoms, but patients who get seriously ill may need a variety of services that are covered by Medicare:
    • Medicare Part A covers inpatient hospital stays, skilled nursing facility (SNF) stays, some home health visits
    • Medicare Part B covers: outpatient services, doctor visits, emergency ambulance transportation, and emergency room visits

Does Medicare cover hospitalizations for COVID-19?

  • Medicare covers all medically necessary hospitalizations. This includes if you’re diagnosed with COVID-19 and you need to stay in the hospital under quarantine.
  • Your hospital costs under Original Medicare 
    • $1,408 deductible for each benefit period.
    • Days 1–60: $0 coinsurance for each benefit period.
    • Days 61–90: $352 coinsurance per day of each benefit period.
    • Days 91 and beyond: $704 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime).
    • Beyond lifetime reserve days: all costs.

Does Medicare cover telehealth or virtual doctors visits?

Medicare has temporarily expanded its coverage of telehealth services. You will be able to receive telehealth services for evaluation and management doctor visits, mental health counseling, and preventive health screenings.

  • Virtual Check-ins: Medicare pays for brief, virtual services that aren’t related to a medical visit within the previous 7 days and doesn’t lead to a medical visit within the next 24 hours (or soonest appointment available).
    • You must have an established relationship with your doctor or other practitioner for these to be covered
    • You must talk to your doctor or other practitioner to start these types of visits.
    • Can be used for the treatment for the COVID-19 from anywhere, including homes, nursing homes, and assisted living facilities.
    • Cost: You pay 20% of the Medicare-approved amount for your doctor or practitioners’ services, and the Part B deductible applies. To find out how much it will cost, talk to your doctor or health care provider when you call to set up these type of visits.
  • E-Visits through online patient portals. E-visits allow you to talk to your doctor using an online patient portal without going to the doctor’s office. 
    • The availability of this service will vary from provider to provider. 
    • Cost: You pay 20% of the Medicare-approved amount for your doctor or practitioners’ services, and the Part B deductible applies. To find out how much it will cost, talk to your doctor or health care provider when you call to set up these type of visits

Will my prescriptions be covered?

  • All drugs covered by Medicare Part D drug plans and Medicare Advantage plans will continue to be covered.
  • If you’re enrolling in a new plan it’s important to check on Medicare.gov or with the help of licensed broker to make sure you’re getting the right plan for your medications because all plans have different lists of drugs they cover (and at different costs)
  • Vaccine – At this time, there’s no vaccine for COVID-19. However, if one becomes available, it will be covered by all Medicare Prescription Drug Plans (Part D), this includes all Medicare Advantage plans. 

Original Medicare vs. Medicare Advantage? Which is the preferred option?

  • Choosing between Traditional Medicare and Medicare Advantage is a personal decision that will depend on your preference for how you want to manage your costs and care. The key is to understand your options and know the differences between them.
  • It’s important to remember that if you choose to stay with Traditional Medicare (Part A & B) instead of a Medicare Advantage plan you should still get a Supplemental insurance plan (Medigap) to protect you against unexpected high costs. This is because even though Traditional Medicare will cover a large percentage of your health costs there is still no maximum to what you could pay when your costs get really high during a serious illness. With Traditional Medicare you also need to add a Prescription Drug Plan (Part D). This is because Parts A & B do not cover prescription drug costs.
  • A Medicare Advantage plan with prescription drug coverage (MA-PD) is essentially Traditional Medicare, Medigap, and a Prescription Drug all rolled up into one plan that you buy from a private insurance company. Each Medicare Advantage plan is different so it’s important to check the details of each plan, but in general you get expanded benefits and lower costs in exchange for being restricted to a smaller network of doctors.
  • Medicare Advantage and COVID-19: If you have a Medicare Advantage Plan, you have access to these same benefits for COVID-19 testing and treatment that do get with Traditional Medicare. Your cost sharing for COVID-19 lab tests will be waived, and many plans offer additional benefits for telehealth.

Will my Medicare coverage change?

  • Whether you’re already on Medicare or are enrolling now, you will not lose any coverage. This includes coverage for doctor visits, medications, hospitalizations, and any other Medicare approved service or enhanced benefit offered by your private Medicare Advantage plan. 
  • And recent legislation has been passed to give you more Medicare coverage related to COVID-19 testing and telehealth services
    • COVID-19 testing and associated medical service costs are now covered by Medicare
    • Expanded coverage for telehealth, including Virtual Check-In services with your doctor

About Trusty:

Trusty is a dual-facing broker and beneficiary Medicare and public benefits enrollment platform that assesses individual’s risk of incurring out of pocket healthcare costs, recommends & enrolls right mix of insurance products providing best coverage, and analyzes eligibility for additional benefits and services.