CMS Issues Guidance To Help Medicare Advantage And Part D Plans Respond To COVID-19

Today, following a meeting with President Trump and Vice President Pence, many leading insurance companies and their industry associations announced they will be treating COVID-19 diagnostic tests as covered benefits and will be waiving cost sharing that would otherwise apply to the test. The President also directed CMS to provide more flexibility to Medicare Advantage and Part D plans to ensure they have the tools they need to provide seniors with the best coverage.  As a result, CMS published a memorandum to Medicare Advantage (MA) and Part D health and prescription drug plans informing them of the flexibilities they have to provide healthcare coverage to Medicare beneficiaries for COVID-19 testing, treatments, and prevention.

“The President directed CMS to make sure Medicare Advantage beneficiaries have access to the healthcare services they need during this time,” said CMS Administrator Seema Verma. “Today we announced guidance to Medicare Advantage and Part D plans to remove barriers that could prevent or delay beneficiaries from receiving care. Medicare beneficiaries are at the greatest risk of serious illness due to COVID-19 and CMS will continue doing everything in our power to protect them.”
In the memorandum issued today, CMS outlines the flexibilities MA and Part D plans have to waive certain requirements to help prevent the spread of COVID-19. These flexibilities include:

• Waiving cost-sharing for COVID-19 tests
• Waiving cost-sharing for COVID-19 treatments in doctor’s offices or emergency rooms and services delivered via telehealth
• Removing prior authorizations requirements
• Waiving prescription refill limits
• Relaxing restrictions on home or mail delivery of prescription drugs
• Expanding access to certain telehealth services

In addition, CMS issued guidance to home health agencies and dialysis facilities in response to COVID-19 outbreak. The guidance offers actionable information to health care workers on screening, treatment and transfer procedures when interacting with patients. The guidance also advises Medicare-enrolled dialysis facilities to identify high risk individuals prior to appointments or upon arrival, and immediately begin screening for symptoms of COVID-19. Additionally, “the guidance recommends screening visitors for potential exposure to the virus, gives detailed instructions for dealing with staff who have either been exposed or are showing signs of illness and offers a list of frequently asked questions that include responses to help safely treat patients in this setting.”



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.

This action is part of the broader effort by the White House Coronavirus Task Force to ensure that all Americans – particularly those at high-risk of complications from the COVID-19 virus – have access to the benefits that can help keep them healthy while helping to contain the spread of this disease.  To keep up to date with the important work CMS is doing in response to COVID-19, please visit the Current Emergencies Website.

To view, CMS’s memorandum for MA and Part D plans, click HERE.  

Summary of CMS’s COVID-19 response actions to date:

Guidance on screening, treatment and transfer procedures
Patient and Providers telehealth benefits in Medicare program
Guidance to hospitals with emergency departments (EDs) on screening, treatment and transfer requirements
FAQs for healthcare providers on Medicare payment for laboratory test
Common Procedure Coding System for certain COVID-19 laboratory tests
Guidance to help State Survey Agencies and Accrediting Organizations prioritize their inspections
New HCPCS code for providers and labs to test patients for COVID-19
Certified laboratories information about how to test for SARS-CoV-2
Critical steps to healthcare facilities to take to prepare for COVID-19


CMS.gov