The COVID-19 public health emergency that began in January 2020 ended on May 11. When that happened, several Medicare rules and waivers that went into effect during the pandemic ended — and that might come as a surprise to Medicare patients.
Many changes were made to adapt to the conditions of the COVID-19 pandemic – when hospitals were overrun, people were encouraged not to leave their homes and patients found themselves receiving medical care in unusual places. Some changes – such as the increased use of telehealth – persist in the near future.
Here are some things Medicare beneficiaries can expect from their benefits after the pandemic.
COVID-19 TESTS, TREATMENTS AND VACCINES
During the public health emergency, or PHE, Medicare and Medicare Advantage covered up to eight at-home COVID tests per month, services related to COVID-19 testing, and antiviral treatments like Paxlovid.
You will now pay out of pocket for at-home COVID-19 testing, although some Medicare Advantage plans may continue to cover it. COVID-19 vaccines will be covered under preventive care. COVID-19 antiviral treatments, such as Paxlovid, will also continue to be covered, but you may need a co-pay or coinsurance for other pharmaceutical treatments for COVID-19, according to KFF, a health policy at non-profit.
During PHE, Medicare covered telehealth services for all Medicare beneficiaries, regardless of location or equipment. This allowed patients to access care from home at a time when going to a healthcare provider seemed risky.
Telehealth coverage has been extended through the end of 2024, with the exception of telehealth provided as part of Medicare hospice benefits.
“This is a significant shift that will continue through 2024,” says Diane Omdahl, president and co-founder of 65 Incorporated, a site that provides Medicare advice. “Maybe they will find out the benefits and extend it again.”
STAY IN QUALIFIED CARE FACILITIES
Before the pandemic, Medicare patients had to be hospitalized for three days before Medicare covered a subsequent stay in a skilled nursing facility. This requirement was lifted during the PHE, but is back in effect.
This waiver created flexibility during the pandemic for hospitals that may not have had space for patients due to high numbers of COVID-19 cases. The return of this rule creates a challenge for patients with Original Medicare, as three-day hospitalizations are rarer than they were when Medicare was enacted in 1965.
“Years ago, everything was done in the hospital,” says Omdahl. Now, many more procedures are done on an outpatient basis, she says.
Members of Medicare Advantage plans can get a head start in this area, as some Advantage plans do not require a three-day stay to qualify for skilled nursing. But many plans require prior approval.
(Any covered stay in a skilled nursing facility that began on or before May 11 will continue to be covered as long as a beneficiary has benefit days and meets the criteria for care.)
During PHE, Medicare Part D prescription drug plans (including Medicare Advantage plans with drug coverage) were required to provide up to a 90-day supply of covered drugs if patients requested it. With the end of the PHE, this is no longer the case.
The Part D plans were also to relax their “too soon filling” limits – safety measures that prevent patients from filling their prescriptions too soon after receiving their previous medication.
Those rules have allowed people to make fewer trips to the pharmacy during the pandemic, but it’s back to business as usual for members of the Part D prescription drug plan.
During PHE, if Medicare Advantage members received care at out-of-network facilities due to the COVID-19 emergency, plans were to cover their care at in-network rates. This requirement will end 30 days after the end of the COVID-19 PHE – which is June 10 – unless there is another declaration of national emergency or state disaster affecting the service area.
In other words, if you have a Medicare Advantage plan, you’ll want to go back to using your network providers, if you haven’t already.
This article originally appeared on the personal finance website NerdWallet. Kate Ashford is a writer at NerdWallet. Email: [email protected]. Twitter: @kateashford.
NerdWallet: Does Medicare Cover COVID Tests, Treatments, and Vaccines? https://bit.ly/nerdwallet-does-medicare-cover-covid-testing-and-vaccines
NerdWallet: Does Medicare Pay for Nursing Home Care? https://bit.ly/nerdwallet-does-medicare-pay-for-nursing-home-care
NerdWallet: What is a Medicare Advantage (Part C) plan? https://bit.ly/nerdwallet-what-is-a-medicare-advantage-plan
NerdWallet: Medicare Part D Drug Coverage: Overview of Benefits and Plan Options https://bit.ly/nerdwallet-what-is-medicare-part-d