Your Protections to Access Care During COVID-19

Living in a time of a public health emergency, the current COVID-19 pandemic, it’s important to know your extra Medicare protections to access health care when you need it. Medicare Advantage and prescription drug plans have certain guidelines they must follow to ensure your access to care. Below is a summary of the important points to know, quoted from the SHIP Technical Assistance Center’s fact sheet, Medicare Coverage and Coronavirus.

Medicare Advantage plans must:

  • Allow you to receive health care services at out-of-network doctor’s offices, hospitals, and other facilities
  • Charge in-network cost-sharing amounts for services received out-of-network
  • Waive referral requirements
  • Suspend rules requiring you to tell the plan before getting certain kinds of care or prescription drugs, if failing to contact the plan ahead of time could raise costs or limit access to care

Prescription Drug plans must:

  • Cover formula Part D drugs filled at out-of-network pharmacies
    • Part D plans must do this when you cannot be expected to get Part D covered drugs at an in-network pharmacy
  • Cover the maximum supply of your refill at your request

In addition, remember that Medicare covers the following COVID-19 related care at no cost to you (i.e. no copayments, coinsurance or deductibles):

  • All COVID-19 tests
  • COVID-19 antibody treatments (monoclonal antibodies)
  • The new COVID-19 vaccine

If you would like assistance accessing the care you need and/or have questions on Medicare’s coverage for COVID-19, contact your local Health Insurance Counseling and Advocacy Program (HICAP). And if you come across any COVID-19 or other scams, report them to our California Senior Medicare Patrol (SMP) at 1-855-613-7080. Also view our newest fraud alert on COVID-19 vaccine scams.