Medicare Advantage Insurers Waiving Cost-Sharing
In response to the COVID-19 emergency, many Medicare Advantage (the private-plan alternative to traditional Medicare) insurers are voluntarily waiving cost-sharing requirements for COVID-19 treatment. This cost-share waiver applies to copays, coinsurance, and deductibles.
UnitedHealthcare, for example, has a $0 copy for covered primary care provider and specialist physician services to all UnitedHealthcare Medicare Advantage members between May 11, 2020, until September 30, 2020. The following services are eligible for $0 from a network provider and out-of-network services covered by the Medicare Advantage plan:
- Primary care provider (PCP) office visits
- Specialist physician office visits
- Physician assistant or nurse practitioner office visits
- Medicare-covered chiropractic and acupuncture services
- Podiatry services and routine eye and hearing exams
- Physical therapy, occupational therapy, and speech therapy
- Cardiac and pulmonary rehabilitation services
- Outpatient mental health and substance abuse visits
- Opioid treatment services
Many other health insurance providers are responding to the COVID-19 emergency with not only cost-sharing waivers but free access to prevention, testing, and treatment to their Medicare Advantage members. Medicare Advantage plans have the flexibility to waive certain requirements with regard to coverage and cost-sharing in cases of disaster or emergency, such as the COVID-19 outbreak. See the list on ahip.org
Other Cost-sharing waivers
As a result of the Families First Coronavirus Response Act and the CARES Act, Medicare Advantage plans are “not permitted to charge cost-sharing for clinical laboratory tests for the detection of SARS-CoV-2 or the diagnosis of the virus that causes COVID-19, the administration of such tests, and specified COVID-19 testing-related services during the period March 18, 2020, through the end of the public health emergency declared by the Secretary under section 319 of the Public Health Service Act,” according to a CMS statement. Medicare Advantage insurers can not (temporarily) impose any prior authorization or other utilization management requirements. Kaiser Family Foundation reports that CMS is allowing the expansion of mid-year benefit enhancements, such as additional or expanded benefits or more generous cost-sharing, as long as they are in connection with the COVID-19 public health emergency. For example, Medicare Advantage plans may add transportation benefits or meal delivery services to promote social distancing during the COVID-19 outbreak. In addition, many Medicare Advantage plans are waiving or reducing cost-sharing for telehealth services.
Got Medicare Advantage Questions?
Medicare Advantage enrollment has grown rapidly over the past decade with more than one-third (36%) of all Medicare beneficiaries opt for a Medicare Advantage plan. The majority of enrollments come from nine states (HI, FL, MN, OR, WI, MI, AL, PA, CT) and Puerto Rico. We hope this information on Medicare Advantage Insurers Waiving Cost-sharing is helpful.
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