CMS Issues Coronavirus Guidance to Medicare Advantage, Medicare Part D Plan Carriers

Follow our Medicare Coronavirus News page for related information on coronavirus (COVID-19) and its impact on Medicare beneficiaries.

In the wake of the coronavirus (COVID-19) pandemic, the Centers for Medicare & Medicaid Services (CMS) released guidance on how Medicare Advantage (Medicare Part C) and Medicare Part D prescription drug plans can properly respond to the outbreak. 

The CMS guidance advises insurers to take measures aimed toward lowering the barrier for beneficiaries to receive care, increasing efficiency and creating opportunities for patients to stay home while still receiving the care that they need.

“Medicare beneficiaries are at the greatest risk of serious illness due to COVID-19, and CMS will continue doing everything in our power to protect them. Today we announced guidance to Medicare Advantage and Part D plans to remove barriers that could prevent or delay beneficiaries from receiving care.” - CMS Administrator Seema Verma

Federal Medicare coronavirus recommendations: What do they mean for private plans?

The CMS coronavirus recommendations for private Medicare plans include:

• Waving all cost-sharing for coronavirus testing, such as copays or coinsurance

• Waiving any cost-sharing related to COVD-19 treatment such as primary care, emergency department and telehealth services

• Eliminate prior authorizations for prescription drugs

• Eliminate restrictions for prescription refills and extend the maximum supply limit 

• Reimburse enrollees for prescriptions obtained at out-of-network pharmacies

• Decrease some limitations surrounding mail delivery prescriptions

• Increase patient access to care through telehealth

The federal Medicare guidance was paired with instructions for health care workers and providers about the proper protocol for wearing masks when treating, transporting and screening patients. 

Medicare beneficiaries at increased risk for coronavirus infection

Medicare beneficiaries are among those at the greatest risk for contracting the coronavirus and the disease it causes, COVID-19. The disease has shown to be deadliest among older adults and those with compromised immune systems or certain pre-existing health conditions.

A study conducted by the Chinese Center for Disease Control and Prevention found that the mortality rate for infected persons age 70 and up was as high as 22 percent.¹

Medicare is providing coverage of coronavirus testing. When a vaccine is developed for the coronavirus, it will also be covered by Medicare.

Compare Medicare Advantage and Part D plans near you

Medicare Advantage (Medicare Part C) provides all the same basic benefits as Original Medicare (Part A and Part B). Most Medicare Advantage plans also cover prescription drugs, and some plans may also cover things like routine dental and vision care.

Because Medicare Advantage plans cover everything that Original Medicare covers, Medicare Advantage plans will also cover COVID-19 vaccines, when one is developed.

Medicare Part D plans offer coverage solely for prescription drugs. 

Both types of plans are sold by private insurance companies, and the costs, availability and benefits of private Medicare plans may vary based on where you live.

¹ Zunyou Wu, et al. (Feb. 24, 2020). Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. doi: doi:10.1001/jama.2020.2648.

Christian Worstell is a health care and policy writer for MedicareSupplement.com. He has written hundreds of articles helping people better understand their Medicare coverage options.