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Your Protections to Access Care During COVID-19

California Health Advocates > News > Medicare Advantage > Your Protections to Access Care During COVID-19

Posted by Karen Joy Fletcher on December 17, 2020

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.

Filed Under: COVID-19, Fraud & Abuse, Medicare Advantage, Medicare Advantage, Prescription Drugs - Blog

Previous Post: « Medicare’s Open Enrollment Ends Monday, Dec 7th
Next Post: No Cuts to Medicaid ~ Submit Your Comments to HHS »

About Karen Joy Fletcher

Our blogger Karen Joy Fletcher is CHA's Communications Director. With a Masters in Public Health from UC Berkeley, she is the online "public face" of the organization, provides technical expertise, writing and research on Medicare and other health care issues. She is responsible for digital content creation, management of CHA’s editorial calendar, and managing all aspects of CHA’s social media presence. She loves being a "communicator" and enjoys networking and collaborating with the passionate people and agencies in the health advocacy field. See her current articles.

Related Posts

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  • CHA Advocates for Ongoing Special Enrollment Periods & Equitable Relief During Pandemic
  • Medicare’s Open Enrollment is Happening Now ~ Review Your Options for 2021

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