Original Medicare and Drug coverage during public health emergency

by | Jul 29, 2020 | Blog, Medicare

Changes to Medicare

  • As of April 1, 2020, your doctor can bill Medicare for the Coronavirus test (provided after February 4, 2020). You will owe nothing for the laboratory test and related provider visits.
  • Virtual check-ins can be used to communicate with your doctor and assess whether you should go to the office for an in-person visit.
  • During the public health emergency, Medicare covers hospital and doctors’ office visits, mental health counseling, preventative health screenings, and other visits via telehealth for all people with Medicare. Deductible, coinsurance, or copayments may still apply.

Changes to drug coverage

  • If you want to refill your prescriptions early so you have extra medication on hand, contact your Part D drug plan. During the emergency, all drug plans must cover up to a 90-day supply of a drug when you ask for it, unless there are certain safety restrictions such as on opioid medications.
  • Drug plans must also suspend rules requiring you to tell the plan before getting certain prescription drugs.
  • Drug plans must cover formulary drugs filled at out-of-network pharmacies if you cannot be expected to get them at an in-network pharmacy.
  • Drug plans must cover the maximum supply of your refill at your request.

Medicare advantage plans may have different costs and coverages than Original Medicare. Advantage plans may have also lifted network requirements, cost-sharing amounts, referral requirements, and certain prior authorization requirements – check with your individual plan to learn more.

Medicaid Purchase Plan (MAPP) changes starting August 2020

  • Monthly out-of-pocket medical and remedial expenses over $500, incurred by member or spouse, may be used as an income deduction.
  • Members with gross income over 100% federal poverty level will have a monthly premium. Lowest monthly premium will be $25 per month.
  • May be able to ask for a temporary premium waiver due to hardship for up to 12 months.
  • Three months of ineligibility for non-payment of premiums instead of six months. Can become reinstated by paying past due premiums.
  • Exempt Independence Accounts will now be exempt for all other Medicaid programs if a recipient loses MAPP eligibility.

Additional Information & Support

We are here to help you and your family with a wide variety of community resource options. For assistance by phone, or to make an appointment, contact us.

(920) 448-4300 | WI Relay 711

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