HHS will reportedly keep the public health emergency declared in the wake of the COVID-19 pandemic and will remain in place through the middle of July and potentially into mid-October or longer.1,2 The news should be a boon to health plans and other stakeholders, which have noted that expiration of the PHE would pose care challenges for enrollees.
The PHE created many pandemic-related health care flexibilities for Medicare Advantage enrollees, including:
- Doing away with or reducing cost sharing for MA enrollees for COVID-19 vaccinations, administration of vaccines, testing and services related to testing and treatment, as well as prohibiting the use of prior authorization or any other utilization management requirements to access these services2
- Increasing the number of telehealth services that MA will cover, including for mental health care, along with eliminating geographic limitations for telehealth and allowing home-based and audio-only telehealth2
- Requiring MA plans to cover services rendered at out-of-network facilities at in-network rates for enrollees who are affected by the PHE2
- Mandating that MA Part D plans provide a 90-day supply of Part D prescriptions to enrollees who request them.2
MA enrollees are taking advantage of the expanded care options afforded to them during the PHE, and plans are responding. For example, nearly half of MA enrollees used telehealth during the first year of the pandemic, and this year, 98% of MA plans include telehealth benefits for members.3 Plans should anticipate continued usage of these expanded benefits and prepare for any coverage changes that could follow the eventual ending of the PHE.
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- Griffin, Riley. US Set to Extend Covid-19 Public Health Emergency Past July. Bloomberg. May 16, 2022. https://www.bloomberg.com/news/articles/2022-05-16/us-set-to-extend-covid-19-public-health-emergency-past-july
- Brownstein Hyatt Farber Schreck. Public Health Emergency Likely to Remain in Place, at Least for Now. Lexology. May 23, 2022. https://www.lexology.com/library/detail.aspx?g=112e536d-d35b-4e4a-8a8c-632a11843f2b
- Cubanski, Juliette; Koma; Wyatt; and Neuman, Tricia. FAQs on Medicare Coverage of Telehealth. Kaiser Family Foundation. May 23, 2022. https://www.kff.org/medicare/issue-brief/faqs-on-medicare-coverage-of-telehealth/