Celebrating 11 years as a Medicare Specialist, October 2019
|
|
Hi there!
In response to the Coronavirus outbreak, I hope you are staying safe and healthy.
In this newsletter, COVID coverage communication from the three carriers for those of you that have UHC , BCBS, AETNA Medicare Advantage plans.
Keep reading!
Theresa Cangemi CSA, CLTC
"The Medicare Lady™"
|
|
From United Healthcare (UHC):
|
Waiving Cost Share for Medicare Advantage Members for Both Primary Care and Specialist Office Visits
|
“Our member’s health is our priority. Recently, we shared news that UnitedHealth Group is taking additional action to directly support people affected by the COVID-19 pandemic by providing over $1.5 billion of additional support for our customers. We wanted to share more details with you.
To help member’s get the care they need, we are waiving cost-share (copays, coinsurance and deductibles) for our Medicare Advantage plan members as follows. Members will have a $0 copay for primary care provider (PCP) and specialist physician services, as well as other covered services (listed below) between May 11, 2020 until at least September 30, 2020. By lowering our PCP and specialist copays to $0, along with our telehealth cost-share waiver, we hope to help make it easier for member’s to access care.
Services included
The following services, if covered by a member’s plan, are eligible for a $0 copay under the cost share waiver, but do not include diagnostic tests and certain other services.
- 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
The $0 copay applies to services from a network provider and out-of-network services covered by the plan.
Member cost share is not waived for the following services, unless they are related to COVID-19 testing or treatments:
- Lab and Diagnostic tests (radiological and non-radiological)
- Part B and Part D drugs
- Durable Medical Equipment, Prosthetics, Orthotics and Supplies
- Renal Dialysis
- Other services not covered by your plan
|
FROM: EXCELLUS BLUE CROSS BLUE SHIELD (BCBS):
COVID-19 Pharmacy Update
|
Our pharmacy team has been closely monitoring the supply of medications that are available during the COVID-19 outbreak.
We’re taking several actions
to ensure our members have access to clinically appropriate medications.
- Providing early refill overrides. Pharmacists can make the override at the point of sale.
- Waiving early medication refill limits on 30-day prescription maintenance medications (consistent with a member’s benefit plan).
- Ensuring formulary flexibility if shortages or access issues do occur.
- Emergency prescription drug overrides are available as part of our standard exception process on an individual member basis.
- Members are encouraged to use their 90-day mail order benefit for prescription medications.
Additionally, please be aware that quantity limits
have been applied to those drugs being investigated and/or used for the treatment of COVID-19.
Don’t Fall For Fraud During COVID-19 Fight
Please remind our members to
be aware that there are various scams and fraudulent activities that can occur during this difficult time.
As is often the case, a national and global emergency brings out people who prey upon the fears and vulnerabilities of others—especially older adults. Being aware of the events members may encounter will help guard against them and prevent them from becoming a victim.
They should be especially wary of
phone calls from people who are asking for a member’s health insurance number, address or other personal information
in order to offer coronavirus-related services or medication. If they receive a call from someone who says they are calling on behalf of our Health Plan, for example, members can always contact us at the number on their member card to verify if we called.
- Be wary of phone calls from people who claim to be from our Health Plan and are asking for your health insurance number, address or other personal information. These callers may offer you free services or medication or offer other false information – contact us at the number on your ID card to verify if not sure.
- Hang up on robocalls. Don’t respond to any questions or press any numbers. Scammers are using illegal robocalls to pitch everything from scam coronavirus treatments to work-at-home schemes. The recording might say that pressing a number will let you speak to a live operator or remove you from their call list, but it might lead to more robocalls, instead.
- Be aware of spear-phishing emails referencing coronavirus or COVID-19, which may contain malware. Do not open any documents or click on any links unless you are absolutely sure they are safe.
- Be aware that scammers may contact people by phone and email and pretend to be doctors and hospitals that have treated a friend or relative for COVID-19, and they may demand payment for that treatment.
- Be wary of scammers going door to door offering free test kits in exchange for insurance information or cash. Don’t accept any other medications (e.g., inhalers) from a person who comes to your door. Your safety is of the utmost importance. Do not open the door for ANYONE you do not know.
- Keep an eye out for fake websites, social media accounts, and email addresses claiming to sell medical supplies currently in high demand, such as surgical masks. When consumers attempt to purchase supplies through these channels, the scammers take the money and never provide the promised supplies.
- Be aware that scammers are creating and manipulating mobile apps designed to track the spread of COVID-19 to insert malware that will compromise users’ devices and personal information.
- Avoid price gouging by individuals and businesses that sell essential goods, like hand sanitizer, for significantly higher prices than normal. Report retailers that appear to take unfair advantage of consumers by selling goods or services that are vital to the health, safety, or welfare of consumers for an excessive price. Report such incidents to the OAG.
- Use caution when making charitable donations. You should never feel rushed or pressured to donate, and never make donations in cash, by gift card, or by money wire. If you receive a charitable solicitation, do some research to determine whether the charity is legitimate.
Here are some helpful resources that provide lists of reputable charities and those that adhere to accountability standards:
If you suspect fraud related to your health insurance, you can:
- Call our Fraud Hotline at 1-800-378-8024.
- Or call the BCBS Federal Employee Program Fraud Hotline 1-800-337-8440.
Telemedicine Visits Covered At No Cost To Members
A reminder for our members; telemedicine visits are being covered at no cost to members for 90 days
beginning with NYS’s State of Emergency issued on March 13, 2020. The purpose is to help alleviate the burden on provider offices, urgent care centers and hospitals as a result of COVID-19.
Providers and members are embracing this method of care in the wake of the COVID-19 pandemic. Our members logged nearly 40,000 telemedicine visits between January 1 and April 3, or about 14,500 more visits than were made in all last year. You can
read more in our recent press release
.
Members should ask their provider in advance if they are equipped to conduct telehealth visits via telephone, e-mail, or video chat.
Our dedicated COVID-19 website
has information on how to register, how to schedule an appointment and more.
Your Benefits and Coverage
|
|
CVS Health extends cost-sharing waivers and announces new action to support Aetna members during the COVID-19 pandemic
|
|
Now covering out-of-pocket costs for primary care services for Medicare Advantage members
This week, we announced that we are extending a range of cost-sharing waivers and benefits to help Aetna members access the care they need during the COVID-19 pandemic. These actions, which were scheduled to expire on June 1, 2020, have been extended through September 30, 2020.
- For members of Aetna Medicare Advantage plans, the company is extending all member cost-sharing and co-pay waivers for inpatient admissions for treatment of COVID-19 or health complications associated with COVID-19.
- Additionally, given the escalating mental health crisis resulting from or amplified by the pandemic, Aetna is extending all member cost-sharing waivers for in-network telemedicine visits for outpatient behavioral and mental health counseling services.
Primary care visits
The company is also taking additional steps to eliminate out-of-pocket costs for primary care services for Medicare Advantage members. Effective from May 13, 2020 through September 30, 2020, Aetna is waiving member out-of-pocket costs for all in-network primary care visits, whether done in-office and via telehealth, for any reason, and encourages members to continue seeking essential preventive and primary care during the pandemic.
Access to medication
In addition to supporting members’ access to needed care, Aetna continues to focus on protecting patient access to medication. It has extended the following actions, which were scheduled to expire on May 15, 2020, through September 30, 2020:
- Waiving early refill limits on 30-day prescription maintenance medications for all members with pharmacy benefits administered through CVS Caremark.
- Continuing to encourage all members of Medicare Advantage plans to use their plan benefits for 90-day maintenance medication prescriptions.
For more information
These announcements build on CVS Health’s overall efforts to help members, customers, providers and communities navigate through this public health emergency. More information on steps CVS Health has taken to address the COVID-19 pandemic is available at the company's
frequently updated COVID-19 resource center
.
|
|
 |
* This article is for information purposes only. I don’t recommend, support, or diagnose any featured writer or article. I am not a doctor. Your health is one of a kind. What works for one person may not for another, so the information in these articles should not take the place of an expert opinion. Before making significant lifestyle or diet changes, please consult your primary care physician or nutritionist. Your doctor will know your own health best.
|
|
|
|
|
|
|
|
|
