CMS (Centers for Medicare and Medicaid Services) has issued several Medicare changes, effective immediately, to support beneficiaries during the coronavirus pandemic.

Medicare Nursing Home Benefits: Coronavirus Waiver of Requirement

Unfortunately, even with the current virus crisis, individuals will still suffer from falls, break hips, have a stroke, develop shortness of breath, and many other issues that will take them to the hospital emergency room.

If your resident, client, or loved one has to go to the emergency room, let them know Medicare has waived the three-day hospital stay requirement for skilled nursing home care.

Medicare typically requires a three-day hospital admission for a Medicare beneficiary to transfer to a skilled nursing home and have it paid for under their Medicare Part A or Part C coverage. CMS announced that they have waived this requirement.

What does this mean for Medicare beneficiaries during the coronavirus pandemic?

If you are taken to the emergency room and require skilled care and are unable to return to your home safely you may be transferred and admitted to a nursing home with Medicare coverage. With this waiver in effect, you do not have to meet the 3-day hospital admission requirement first.

Once admitted to the nursing home, the Medicare beneficiary typically has up to 100 days of care that may be paid for under Medicare Part A. If you exhaust those benefits Medicare has also authorized that this coverage can be renewed without the start of a new Medicare benefit period.

Medicare Advantage Part C Plans: Coronavirus Changes to Access Providers

If your Medicare is through a Part C Medicare Advantage Plan, the plans will cover needed medical services at non-contracted facilities and health care providers. You won’t require a gatekeeper referral and your cost-sharing will remain the same as if using a contracted facility or health care facility.

Receiving Medications through Medicare Part D During Coronavirus

Now may be the time to order your medications online. Part D plans may relax restrictions for home or mail delivery. You may want to switch to a 90-day mail-order prescription.

Medicare Rules have been relaxed for Medicare Part D prescription plans and the Part D plans may provide enrollees with a maximum extended supply of medications. Medicare Part D plans are required to reimburse enrollees who have to utilize out-of-network pharmacies to obtain their medications. Part D insurers may waive prior authorization requirements.

There will be no pre-authorization requirements for drugs used to treat or prevent COVID-19.

Medicare Coverage for Telehealth

Medicare is allowing physicians and health care providers to provide care through telehealth.

What does that mean to you?

You may utilize a local telehealth provider and they are allowed to bill Medicare for the online visit.

Our care management team is working with their clients to educate them on such changes and advocate for their needs. We are continually evaluating client plans and helping them be prepared for social isolation and accessing help during the pandemic. If you have concerns for a loved one, encounter difficulties or need help finding information or resources, reach out to us anytime online or at 727-447-5845 or 813-333-5020.