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Medicare adjustments to COVID-19

William C. Lane, PhD
Posted 6/28/20

As the majority of older adults continue to practice social distancing in response to the COVID-19 virus, Medicare is continuing to adjust to this “new normal.” For the foreseeable future we are …

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Medicare adjustments to COVID-19

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As the majority of older adults continue to practice social distancing in response to the COVID-19 virus, Medicare is continuing to adjust to this “new normal.”

For the foreseeable future we are all going to be adjusting to new ways of limiting our close contact with others while still continuing to live our lives. Medicare is making almost daily changes to assist us in accommodating the demands of this new normal. 

Updates in Medicare coverage. First, Medicare will fully cover the lab test for COVID-19 but will now also fully cover the costs of the antibody or “serology” tests. This testing regiment will be prescribed if you were diagnosed with a COVID-19 infection or you are suspected of having had such an infection. Finally, Medicare will cover all the expenses, subject to the usual co-payments, related to a hospital stay resulting from COVID-19.

You will also be covered if you are required to remain in the hospital under quarantine. If you use the Veterans Administration for your health care you should be aware that military hospitals do not bill Medicare. Ask the VA if you are covered for any COVID-19 related treatment before you enter. Other important coverage issues include the following:

While there is currently no vaccine for COVID-19, Medicare is assuring all beneficiaries that the cost will be fully covered when one becomes available.

All Medicare Advantage Plans are required to cover the same COVID-19 related costs as Original Medicare. Many plans offer additional benefits, such as meal delivery or medical transportation. Check with your plan to make sure that these additional benefits will apply if they are activated in response to a case of the virus. 

Continue to remain on the lookout for scammers. Only give out your Medicare number to trusted medical professionals and check your Medicare claims summaries for possible fraudulent charges.

Telehealth services. As we discussed last month, Medicare has temporarily expanded its coverage of telehealth services. There is every indication that many of the services will become a permanent part of your Medicare benefits. The services now cover “virtual visits” with your health care providers.

The list of providers, which not only includes doctors and nurse practitioners, now also includes physical and occupational therapists as well as speech language pathologists. If you are using telehealth your provider will send you a secure access link that will allow you to connect with provider during a scheduled appointment. Some of the access rules include:

Using telehealth will allow you to have a “virtual check-in” if it is not related to a medical visit that has occurred in the last seven days. Your provider will contact you to obtain a verbal consent to use the virtual check-in format.

I recently received a call from a physician’s office to see if I was willing to move a scheduled one-year surgical follow-up appointment from an in-person to a “Zoom visit” which I gladly agreed to do. Within a few minutes I received an e-mail message containing the video link. My appointment time remained the same. 

Your usual Medicare co-payments will apply to a telehealth appointment.

Other ways Medicare is making adjustments. Medicare is issuing new regulations designed to meet the challenges brought on by the virus. Some of most recent changes include:

Providing special enrollment periods for those who missed their chance to enroll in a Medicare health or drug plan due to COVID-19 during the January through March enrollment period. Unfortunately, these special periods all ended either on June 17 or July 1.

Advocates are working to have these periods extended or new ones established. 

Allowing Medicare Advantage Plans and Part D Drug Plans to waive or relax their prior authorization requirements. 

Increasing the efforts at infection control in nursing homes to counter the spread of the virus. It should be noted that the first reported death from COVID-19 occurred in a nursing home in Kirkland, Wash. (officials now believe that it may have actually occurred in Santa Clara, Calif.).

According to the Wall Street Journal, by early June at least 35 residents in that nursing home had died from the virus. That Kirkland nursing home carries a prestigious 5-Star rating on the Medicare Nursing Home Compare website. 

Issuing important guidance in answering questions that nursing homes may have with respect to addressing cases of COVID-19.

Communicating remotely with someone who has dementia. As the restrictions remain in place on younger family members visiting older members, especially in nursing homes, the issue of how to communicate remotely with someone with dementia has come to the forefront.

Karen Harrison Denning, in an article for Dementia UK (How to Communicate with Someone with Dementia Remotely, www.dementiauk.org) has presented an excellent set of tips and guidelines for both caregivers and family. In the article she covers both traditional telephone calls as well as video options.

If you have a relative or friend you are trying to communicate with during these trying times, I urge you check out this article. You can also find a publication titled, “Tips for Better Communication Leaflet” on the same website.

Who do I contact in Oneida County with Medicare and other health insurance related questions? Usually, the paragraph at the end of each article directs readers to one of two locations, the North Utica Senior Citizens Community Center or the Copper City Community Connection (formally the Ava Dorfman Senior Citizens Civic Center), where counselors are available. However, both of these facilities will remain closed until after this emergency is over.  

All HIICAP counseling services are now being provided directly by Oneida County Office for Aging and Continuing Care/NY Connects. Anyone with questions about any issues with your Medicare or long-term care insurance coverage can call the office directly at 315-798-5436 anytime during normal business hours. You will be directed to a trained counselor who can assist you.In order to maintain physical or social distancing all counseling services will be conducted over the telephone. All home visits and face-to-face counseling service have been suspended.

Dr. William Lane is the owner of William Lane Associates, a gerontological firm located in Homer, NY. He writes a monthly column on HIICAP related issues for the OFA. Dr. Lane does not sell insurance, work for any insurance company or recommend any insurance products.

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