Do your clients have questions about recent Medicare developments? Here’s a look at what’s been happening and what you should tell your clients.
COVID-19 Vaccines Are Here
COVID-19 vaccines are here, and they are covered by Medicare. CMS says that Original Medicare enrollees will pay nothing for the FDA-approved COVID-19 vaccine.
What should beneficiaries know? States are responsible for the distribution of COVID-19 vaccines. Due to a limited supply, eligibility for a vaccine is being done in phases. Beneficiaries can use the “How Do I Get a Vaccine?” tool on the CDC website to see when and how they can get a vaccine in their state.
Medicare beneficiaries should also watch out for scammers trying to take advantage of the situation. For example, scammers might pose as a health or government agencies offering signups for the vaccine in order to steal information from people. You cannot pay to put your name on a waiting list or to get early access to the vaccine, and anyone offering this is a scammer.
New Rule Create Price Transparency for Prescriptions
On January 15, CMS announced a new rule that will impact Medicare Advantage and Medicare Part D plans. Under the new rule, plans will have to offer a real-time benefit comparison tool that lets beneficiaries find out what they will pay and learn about lower-cost options that are considered equally effective. For example, if a doctor prescribes a medication, the enrollee will be able to use the tool to see how much it will cost. The enrollee will also be able to look at alternative treatments and see how much they cost.
What should beneficiaries know? This will be a big deal for beneficiaries, but plans don’t need to introduce the cost-comparison tool until January 1, 2023. Beneficiaries will have to wait a while.
Coverage for Breakthrough Devices to be Streamlined
CMS says it is creating Medicare Coverage of Innovative Technology (MCIT), a new pathway for national Medicare coverage of innovations in the FDA Breakthrough Device Program. The new pathway will apply to devices, including some diagnostic tests, that have been granted breakthrough status by the FDA and that fit into a Medicare benefit category.
What should beneficiaries know? The new MCIT pathway should result in faster coverage of breakthrough devices, giving Medicare beneficiaries new options for care. CMS says it will post a list of breakthrough devices that are covered through MCIT on the CMS website, so this is something that interested patients and providers should watch for.