CMS encourages Medicare Advantage plans to remove barriers to COVID-19 care

The CMS has encouraged Medicare Advantage plans to eliminate or reduce cost-sharing for their members affected by the coronavirus outbreak.

Medicare Advantage, the private alternative to the traditional Medicare program, serves roughly 22 million seniors and disabled adults. The Centers for Disease Control and Prevention has said that older adults and people with serious chronic medical conditions are at a higher risk of becoming very sick from COVID-19.

The CMS on Tuesday evening issued information that outlines the flexibilities Advantage and Part D prescription drug plans have to waive requirements to “help prevent the spread of COVID-19.”

Plans may waive or reduce cost-sharing for coronavirus tests and treatments delivered in doctor’s offices, emergency departments or via telehealth, the agency said. They may also remove prior authorization requirements, lift limits on prescription refills, relax restrictions on home delivery of prescription drugs, and expand access to certain telehealth services, according to the memo.

“These waivers break down barriers to beneficiaries accessing care and allow plans to work with pharmacies and providers to treat patients without burdensome requirements limiting their options during this outbreak,” the CMS said in a news release announcing the guidance.

Medicare has previously said it would cover a vaccine for COVID-19 if one becomes available.

Though the steps outlined by the CMS are voluntary, many health insurers have already pledged to eliminate out-of-pocket costs for tests and telehealth visits for their members affected by coronavirus, including Medicare Advantage enrollees. Some have gone farther by promising to waive cost-sharing for the related doctor’s visit.

Also in the guidance, the CMS outlined special requirements for health insurers in states that have declared a state of emergency. So far, at least eight states have done so. Medicare Advantage insurers in those states must immediately cover Medicare Parts A, B and C benefits at out-of-network facilities and provide the same cost-sharing for the plan member as if the service had been provided at an in-network facility. Plans also must waive requirements for referrals, the CMS said.