Celebrating 11 years as a Medicare Specialist, October 2019
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Hi there!
As daily life continues to shift in response to the Coronavirus outbreak, I hope you are staying safe and healthy.
THERE IS A LOT OF INFORMATION AND RESOURCES IN THIS NEWSLETTER, SO PLEASE READ CAREFULLY.
- In response to the Coronavirus, I have included some information from MEDICARE about testing, coverage, and a government resources.
- There is also information from United Healthcare, Excellus BCBS, and Aetna about Corona tests and coverage; and referral resource services.
- SCAM WARNING notice included: Potential scams related to Coronavirus (COVID-19).
Keep reading!
Theresa Cangemi CSA, CLTC
"The Medicare Lady™"
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Medicare’s coverage of Coronavirus-related services
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In general, Medicare covers medically necessary items and services that a beneficiary receives from a provider who accepts Original Medicare (Part A and Part B) or is in-network for the beneficiary’s Medicare Advantage Plan.
Medicare Advantage Plans must cover everything that Original Medicare does, but they can do so with different costs and restrictions. However, plans must meet certain requirements following the declaration of a disaster, emergency, or public health emergency.
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Here is some additional information from Medicare Rights Center:
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Coronavirus resources for Medicare beneficiaries in New York
As state and local health departments continue to take proactive measures against COVID-19 (also called Coronavirus), it is important that Medicare-eligible individuals have access to the information they need to stay prepared. Please share the following list of resources to help keep beneficiaries (Medicare eligibles) informed and ensure timely access to appropriate care.
Counselors on the Medicare Rights’ National Helpline are available at 800-333-4114, Monday through Friday. We are ready to answer questions about Medicare, including those
related to the Coronavirus
, and resolve complex cases related to Medicare and/or Medicaid including prescription drug access, behavioral health, Medicaid long-term care, and other issues. We can also help connect people to additional community resources.
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Resources from the Medicare Rights Center:
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Additional resources for New Yorkers:
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Food Delivery for SNAP enrollees
Individuals receiving Supplemental Nutrition Assistance Program (SNAP) benefits have the option of using EBT cards to purchase food and have it delivered via Amazon, ShopRight, or Walmart (delivery fees must be paid separately using a debit or credit card.)
Congress is continuing work on Coronavirus relief bills.
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Access to TELEHEALTH coverage temporarily expanded
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In response to the current Coronavirus emergency, the Centers for Medicare & Medicaid Services (CMS) temporarily implemented new telehealth coverage flexibilities. Specifically, Medicare beneficiaries can now receive coverage for telehealth services regardless of where they are located (normally Original Medicare only covers telehealth for beneficiaries living in rural areas or to treat behavioral health conditions).
This temporary expansion should allow beneficiaries to access telehealth benefits from their homes or other community locations.
For more information about Medicare coverage of telehealth services during the Coronavirus emergency, see CMS’s
provider fact sheet
and
FAQ
.
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Skilled nursing facility three-day stay waiver
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Medicare Part A generally only covers
skilled nursing facility (SNF) care
if someone was a hospital inpatient for three days in a row before entering the SNF. This is known as the three-day qualifying hospital stay.
At this time, Medicare has removed the three-day qualifying hospital stay requirement for beneficiaries who experience dislocations or are otherwise affected by the coronavirus public health emergency. According to CMS, this waiver includes but is not limited to beneficiaries who need to be transferred to a SNF—due to nursing home evacuations or to make room at local hospitals, for example—as well as people who need SNF care as a result of the current public health emergency, regardless of whether they were previously in the hospital.
Medicare is also easing other SNF-related coverage requirements. Typically, Medicare Part A covers up to 100 days of SNF care each benefit period. A benefit period begins when a beneficiary is admitted to a hospital as an inpatient, or to a SNF, and it ends when they have been out of a SNF or hospital for at least 60 days in a row. The 100 days of covered SNF care resets at the beginning of a new benefit period. Recognizing that current circumstances may make this renewal process uniquely difficult, Medicare is allowing an exception. Beneficiaries who are unable to start a new benefit period because of the public health emergency can get another 100 days of covered SNF care without having to begin a new benefit period.
For more information about the SNF three-day stay waiver, see CMS’s
memo
.
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Changes to Medicaid home care access
New York State Department of Health (NYSDOH) released new guidance for authorization of community based long-term care services and supports. This guidance provides instruction for handling assessments for Medicaid beneficiaries in need of or receiving long-term care services.
A physician’s order is still required to access Personal Care Services (PCS) and Consumer Directed Personal Assistance Services (CDPAS). However, physicians are encouraged to complete the required physician’s order via telephone or covered telehealth. During this period, community health assessments for these and other long-term care services and supports may also be conducted by telephone or telehealth. NYSDOH is also suspending all required periodic reassessments for Medicaid beneficiaries receiving home care services.
The state also informed the Human Resources Administration in New York City that based on recently signed federal legislation, no person who currently has Medicaid coverage will lose their coverage during the coronavirus pandemic.
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United Healthcare Updates for Members:
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- HouseCalls has been paused
- OTC (over the counter items) for DSNP (Medicare/Medicaid) members: Any monies not used in March, will be rolled over to April
- Since Covid-19 updates are consistently changing, email is the main mode of communication for our members. At this time, roughly 40% of members have an email address on file with us.
- New member outreach calls have been suspended
- Virtual visits through AmWell are still $0
- 1-800-643-4845
- http://www.amwell.com
- Testing for COVID-19 is $0- treatment will fall under regular copays
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Take Advantage: Social & Government Referral Services
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Social and Government Referral Services is available to help
UnitedHealthcare Medicare Advantage members get more for their Medicare dollar. We have teamed up with Benelynk and Change Healthcare to help connect members with resources that they may be eligible for, such as access to food, housing, transportation and financial stability.
Members may receive a letter from
UnitedHealthcare regarding the renewal process for this service. The letter will ask them to sign and return an Appointment of Representative form giving Benelynk or Change Healthcare permission to represent them while utilizing the service.
If you receive questions related to this, Benelynk and Change Healthcare are working on behalf of UnitedHealthcare.
- Social Security has closed all of their office for in-person appointments.
- Here are SOME grocery stores that have implemented Senior Hours.
- Green Hills Farms in Nedro
- Price Chopper: 6-7AM
- BJ’s Whole Sale Club: 7-8AM
- For your snow birds in Florida,
- Publix is opening Tuesday & Wednesday 7-8AM
MENTAL HEALTH
- Emotional support line is here for you to call any time at 866-342-6892. This 24/7 Optum Help Line is staffed by professionally trained mental health experts. It is free of charge and open to anyone. In a stressful time, it can be hard to cope. Talking to someone can help.
- On-demand emotional support is also available to you through Sanvello, a free mobile app that can help you cope with stress, anxiety and depression during the COVID-19 pandemic.
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Aetna Medicare members now have access to a variety of resources and enhanced benefits including:
- $0 co-payment on all telehealth visits with your doctor Aetna Medicare is expanding coverage of telehealth and offering all telehealth visits at no out-of pocket cost to members (copays are waived) until further notice. This will help Medicare plan members get the care they need while lowering their risk of exposure to COVID-19.
- No co-pays for diagnostic testing related to COVID-19 This policy will cover the cost of physician-ordered testing for patients who meet CDC guidelines.
- Dedicated support you can count on. For members that have underlying conditions putting them at greater risk for developing complications around the Coronavirus, Aetna care managers will reach out to them directly.
- You won’t have to pay a fee for home delivery of prescription medications from CVS Pharmacy. Members can limit their exposure to the virus and avoid passing it around by having their medications (excluding over-the-counter medications) delivered. CVS Pharmacy has waived charges for home delivery of prescription medications.
- You can get your refill early if you need it. For Aetna Medicare plan’s with Part D drug coverage, members can get refills early, and for many of the medications we cover, they can get a 90-day supply.
Don't forget about these extra plan benefits, with Aetna:
- Online video workouts All Aetna Medicare members can access an on-demand library of workouts, wellness videos and exercise programs, at no extra cost, with the SilverSneakers fitness benefit. Over 100+ on demand workout videos are available through SilverSneakers.com or the SilverSneakers GO fitness app. This means members can take classes like yoga, cardio, strength training and circuit training, even while hunkered down at home. To get started, members just need to go to SilverSneakers.com, create an online account, login, and then select a video.
- Call a registered nurse anytime. With the Medicare nurse hotline, members can talk to a registered nurse, day or night. They can help members decide if a doctor or urgent care visit is needed, understand their symptoms or learn about treatment. Members can call the hotline at 1-800-556-1555 (TTY: 711) anytime. Note: Staff on the nurse call line cannot diagnose, prescribe or give medical advice. Members should call their doctor with any questions or concerns about your health.
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Excellus BlueCross BlueShield Updates on COVID-19 (Coronavirus)
- No cost to members for COVID-19 testing where medically necessary consistent with CDC guidance
- No cost to members for medically necessary office, urgent care, or ER visits related to COVID-19
- No cost to members for telehealth services where plans include a telehealth benefit
Please check out our new COVID-19 resource website,
ExcellusBCBS.com/covid19
, for easy access to updates, common questions about coverage, helpful tips and resources.
The COVID-19 situation is rapidly changing, and this website will be updated regularly with new information.
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SCAM WARNING: Potential scams related to Coronavirus (COVID-19).
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The Federal Trade Commission (FTC) says scammers can and will try to take advantage of people throughout the crisis, and have issued the following tips:
- Hang up on robocalls. Don’t 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.
- Ignore online offers for vaccinations and home test kits. Scammers are trying to get you to buy products that aren’t proven to treat or prevent the Coronavirus disease 2019 (COVID-19) — online or in stores. At this time, there also are NO FDA-authorized home test kits for the Coronavirus.
- Fact-check information. Scammers, and sometimes well-meaning people, share information that hasn’t been verified. Before you pass on any messages, contact trusted sources.
- Know who you’re buying from. Online sellers may claim to have in-demand products, like cleaning, household, and health and medical supplies when, in fact, they don’t.
- Don’t respond to texts and emails about checks from the government. The details are still being worked out. Anyone who tells you they can get you the money now is a scammer.
- Don’t click on links from sources you don’t know. They could download viruses onto your computer or device.
- Do your homework when it comes to donations, whether through charities or crowdfunding sites. Don’t let anyone rush you into making a donation. If someone wants donations in cash, by gift card, or by wiring money, don’t do it.
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* 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.
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