TableofContents

Glossary……………………………………………………………………………………………………………………………………………..2

COVID-19Testing/Treatment……………………………………………………………………………………………………………..9

• GroupHealthPlans,Self-Insured(Self-Funded)PlansandIndividualorGroupCoveragethroughtheMarketplace

• Medicare/MedicareAdvantage• MedicalAssistance(MA)andManagedCareOrganizations(MCOs)• CommunityHealthChoices(CHC)• PEBTF(PennsylvaniaEmployeesBenefitTrustFund)• Children’sHealthInsuranceProgram• TRICARE,CoverageforVeterans,andCoverageforFederalCivilians• IndianHealthServices

CommonQuestions-WhatShouldIDoIf………………………………………………………………………………………….15

• Igotabillfortesting• Ihavehealthconcernsthatrequireemergencymedicalservices• Idon'thavehealthinsurance• I’vebeenlaidoffandInolongerhavehealthinsurance,whatdoIdo?

o CobraCoverageandtheMarketplaceo ReductioninIncomeo COBRA/Mini-COBRAFAQ

• Ifmyinsurancewon’tcoverCOVID-19testingortreatment• Iwanttorefillmyprescriptionsearlytohavemoreonhand• Iwanttoreceiveassistanceviatheuseoftelehealthfromaprovideroutsideofthe

CommonwealthofPennsylvania• CanmyinsurancecarriercancelorrefusetorenewmyinsurancepolicyifIamdiagnosedwith

COVID-19?Cantheydenymyclaimforapre-existingcondition?• IfIhaveMedicalAssistanceorCHIPcoverage

FederalLegislation……………………………………………………………………………………………………………………………20Scams……………………………………………………………………………………………………………………………………………….21WheretoGoforHelp………..………………………………………………………………………………………………………………23

• ThePennsylvaniaInsuranceDepartment• TheUnitedStatesDepartmentofLabor(Self-InsuredCoverage)• Medicare• ThePennsylvaniaDepartmentofHumanServices(Medicaid/MedicalAssistance)• Pennsylvania’sChildren’sHealthInsuranceProgram(CHIP)• StateVeteransServices• PALinktoAgingandDisabilityServices

AdditionalMedicareinformation………………………………………………………………………………………………………24

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GlossaryAffordableCareAct(ACA):ThecomprehensivehealthcarereformlawenactedinMarch2010(sometimesknownasACA,PPACA,or“Obamacare”).Thelawhas3primarygoals:

• Makeaffordablehealthinsuranceavailabletomorepeople.Thelawprovidesconsumerswithsubsidies(“premiumtaxcredits”)thatlowercostsforhouseholdswithincomesbetween100%and400%ofthefederalpovertylevel.

• ExpandtheMedicaidprogramtocoveralladultswithincomebelow138%ofthefederalpovertylevel.(NotallstateshaveexpandedtheirMedicaidprograms;PennsylvaniadidexpandMedicaid.)

• Supportinnovativemedicalcaredeliverymethodsdesignedtolowerthecostsofhealthcaregenerally.

CatastrophicHealthPlan:HealthplansthatmeetalloftherequirementsapplicabletootherQualifiedHealthPlans(QHPs)butthatdon'tcoveranybenefitsotherthan3primarycarevisitsperyearbeforetheplan'sdeductibleismet.ThepremiumamountyoupayeachmonthforhealthcareisgenerallylowerthanforotherQHPs,buttheout-of-pocketcostsfordeductibles,copayments,andcoinsurancearegenerallyhigher.ToqualifyforaCatastrophicplan,youmustbeunder30yearsoldORgeta"hardshipexemption"becausetheMarketplacedeterminedthatyou’reunabletoaffordhealthcoverage.CertifiedApplicationCounselor:Anindividual(affiliatedwithadesignatedorganization)whoistrainedandabletohelpconsumers,smallbusinesses,andtheiremployeesastheylookforhealthcoverageoptionsthroughtheMarketplace,includinghelpingthemcompleteeligibilityandenrollmentforms.Theirservicesarefreetoconsumers.Children’sHealthInsuranceProgram(CHIP):Insuranceprogramthatprovideslow-costhealthcoveragetochildreninfamiliesthatearntoomuchmoneytoqualifyforMedicaidbutnotenoughtobuyprivateinsurance.Insomestates,CHIPcoverspregnantwomen.

EachstateoffersCHIPcoverageandworkscloselywithitsstateMedicaidprogram.Youcanapplyanytime.Ifyouqualify,yourcoveragecanbeginimmediately,anytimeofyear.

CHIPManagedCare:ManagedCareisahealthcaredeliverysystemorganizedtomanagecost,utilization,andquality.Children’sHealthInsuranceProgram(CHIP)managedcareprovidesforthedeliveryofCHIPhealthbenefitsthroughcontractedarrangementsbetweenstateCHIPagenciesandmanagedcareplansthatacceptasetpermemberpermonth(capitation)paymentfortheseservices.COBRA:Afederallawthatmayallowyoutotemporarilykeephealthcoverageafteryouremploymentends,youlosecoverageasadependentofthecoveredemployee,oranotherqualifyingevent.IfyouelectCOBRA

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(ConsolidatedOmnibusBudgetReconciliationAct)coverage,youpay100%ofthepremiums,includingthesharetheemployerusedtopay,plusasmalladministrativefee.Coinsurance:Thepercentageofcostsofacoveredhealthcareserviceyoupay(20%,forexample)afteryou'vepaidyourdeductible.Let'ssayyourhealthinsuranceplan'sallowedamountforanofficevisitis$100andyourcoinsuranceis20%.

• Ifyou'vepaidyourdeductible:Youpay20%of$100,or$20.Theinsurancecompanypaystherest.

• Ifyouhaven'tmetyourdeductible:Youpaythefullallowedamount,$100.ExampleofcoinsurancewithhighmedicalcostsLet'ssaythefollowingamountsapplytoyourplanandyouneedalotoftreatmentforaseriouscondition.Allowablecostsare$12,000.

• Deductible:$3,000• Coinsurance:20%• Out-of-pocketmaximum:$6,850

You'dpayallofthefirst$3,000(yourdeductible).You'llpay20%oftheremaining$9,000,or$1,800(yourcoinsurance).So,yourtotalout-of-pocketcostswouldbe$4,800—your$3,000deductibleplusyour$1,800coinsurance.Ifyourtotalout-of-pocketcostsreach$6,850,you'dpayonlythatamount,includingyourdeductibleandcoinsurance.Theinsurancecompanywouldpayforallcoveredservicesfortherestofyourplanyear.Generallyspeaking,planswithlowmonthlypremiumshavehighercoinsurance,andplanswithhighermonthlypremiumshavelowercoinsurance.Copayment:Afixedamount($20,forexample)youpayforacoveredhealthcareserviceafteryou'vepaidyourdeductible.Let'ssayyourhealthinsuranceplan'sallowablecostforadoctor'sofficevisitis$100.Yourcopaymentforadoctorvisitis$20.

• Ifyou'vepaidyourdeductible:Youpay$20,usuallyatthetimeofthevisit.• Ifyouhaven'tmetyourdeductible:Youpay$100,thefullallowableamountforthevisit.

Copayments(sometimescalled"copays")canvaryfordifferentserviceswithinthesameplan,likedrugs,labtests,andvisitstospecialists.

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Generallyplanswithlowermonthlypremiumshavehighercopayments.Planswithhighermonthlypremiumsusuallyhavelowercopayments.CostSharing: Theshareofcostscoveredbyyourinsurancethatyoupayoutofyourownpocket.Thistermgenerallyincludesdeductibles,coinsurance,andcopayments,orsimilarcharges,butitdoesn'tincludepremiums,balancebillingamountsfornon-networkproviders,orthecostofnon-coveredservices.CostsharinginMedicaidandCHIPalsoincludespremiums.Deductibles:Theamountyoupayforcoveredhealthcareservicesbeforeyourinsuranceplanstartstopay.Witha$2,000deductible,forexample,youpaythefirst$2,000ofcoveredservicesyourself.Afteryoupayyourdeductible,youusuallypayonlyacopaymentorcoinsuranceforcoveredservices.Yourinsurancecompanypaystherest.

• Manyplanspayforcertainservices,likeacheckupordiseasemanagementprograms,beforeyou'vemetyourdeductible.Checkyourplandetails.

• AllMarketplacehealthplanspaythefullcostofcertainpreventivebenefitsevenbeforeyoumeetyourdeductible.

• Someplanshaveseparatedeductiblesforcertainservices,likeprescriptiondrugs.• Familyplansoftenhavebothanindividualdeductible,whichappliestoeachperson,anda

familydeductible,whichappliestoallfamilymembers.Generally,planswithlowermonthlypremiumshavehigherdeductibles.Planswithhighermonthlypremiumsusuallyhavelowerdeductibles.ExchangeAssister:InPennsylvania,anExchangeAssisterisanindividualororganization,includingaNavigator,NavigatorOrganizationorCertifiedApplicationCounselor(CAC)whoprovidespubliceducationorassistsconsumersfororonbehalfoftheAffordableCareActMarketplace.Thistermdoesnotincludealicensedinsuranceproducer.Thistermalsodoesnotincludeanindividualemployedtoprovideinsuranceenrollmentorcoverageassistancebyahealthcarefacilityasdefinedinsection103oftheactofJuly19,1979(P.L.130,No.48),knownastheHealthCareFacilitiesAct.GroupHealthPlan:Ingeneral,ahealthplanofferedbyanemployeroremployeeorganizationthatprovideshealthcoveragetoemployeesandtheirfamilies.HealthCoverage:Legalentitlementtopaymentorreimbursementforyourhealthcarecosts,generallyunderacontractwithahealthinsurancecompany,agrouphealthplanofferedinconnectionwithemployment,oragovernmentprogramlikeMedicare,Medicaid,ortheChildren’sHealthInsuranceProgram(CHIP).IndividualHealthInsurancePolicy:Policiesforpeoplethataren'tconnectedtojob-basedcoverage.Individualhealthinsurancepoliciesareregulatedunderstatelaw.

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In-network:Thehospitalorproviderhasacontractwithyourinsurancecompany.Contactyourinsurancecompanyorvisititswebsiteforalistofin-networkhospitalsandproviders.LargeGroupHealthPlan:Ingeneral,agrouphealthplanthatcoversemployeesofanemployerthathas51ormoreemployees.

LIFE:LivingIndependentlyfortheElderly(Life)isaMedicareandMedicaidprogramthathelpspeoplemeettheirhealthcareneedsinthecommunityinsteadofgoingtoanursinghomeorothercarefacility.Marketplace:Shorthandforthe“HealthInsuranceMarketplace,”ashoppingandenrollmentserviceformedicalinsurancecreatedbytheAffordableCareActin2010.Inmoststates,thefederalgovernmentrunstheMarketplace(sometimesknownasthe"exchange")forindividualsandfamilies.Ontheweb,it'sfoundatHealthCare.gov.

• FilloutaMarketplaceapplicationandyou’llfindoutifyouqualifyforlowermonthlypremiumsorsavingsonout-of-pocketcostsbasedonyourincome.

• YoumayfindoutifyouqualifyforMedicaidortheChildren’sHealthInsuranceProgram(CHIP).Youcanshopforandenrollinaffordablemedicalinsuranceonline,byphone,orwithin-personhelpfromatrainedassisteroranagentorbroker(inPennsylvaniaagentsandbrokersarecalledproducers).MedicalAssistance(MA),alsoknownasMedicaid:Insuranceprogramthatprovidesfreeorlow-costhealthcoveragetosomelow-incomepeople,familiesandchildren,pregnantwomen,theelderly,andpeoplewithdisabilities.ManystateshaveexpandedtheirMedicaidprogramstocoverallpeoplebelowcertainincomelevels.

WhetheryouqualifyforMedicaidcoveragedependspartlyonwhetheryourstatehasexpandeditsprogram.Medicaidbenefits,andprogramnames,varysomewhatbetweenstates.

Youcanapplyanytime.Ifyouqualify,yourcoveragecanbeginimmediately,anytimeofyear.

Medicare:Afederalhealthinsuranceprogramforpeople65andolderandcertainyoungerpeoplewithdisabilities.ItalsocoverspeoplewithEnd-StageRenalDisease(permanentkidneyfailurerequiringdialysisoratransplant,sometimescalledESRD).Medicareisn’tpartoftheHealthInsuranceMarketplaceMedicareAdvantage(MedicarePartC):AtypeofMedicarehealthplanofferedbyaprivatecompanythatcontractswithMedicaretoprovideyouwithallyourPartAandPartBbenefits.MedicareAdvantagePlansincludeHealthMaintenanceOrganizations,PreferredProviderOrganizations,PrivateFee-for-ServicePlans,SpecialNeedsPlans,andMedicareMedicalSavingsAccountPlans.Ifyou’reenrolledinaMedicareAdvantagePlan,mostMedicareservicesarecoveredthroughtheplanandaren’tpaidforunderOriginalMedicare.MostMedicareAdvantagePlansofferprescriptiondrugcoverage.

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MedicarePartD:AprogramthathelpspayforprescriptiondrugsforpeoplewithMedicarewhojoinaplanthatincludesMedicareprescriptiondrugcoverage.TherearetwowaystogetMedicareprescriptiondrugcoverage:throughaMedicarePrescriptionDrugPlanoraMedicareAdvantagePlanthatincludesdrugcoverage.TheseplansareofferedbyinsurancecompaniesandotherprivatecompaniesapprovedbyMedicare.Mini-COBRA:OrAct2of2009,isaPennsylvanialawthatgivesemployeesofsmallbusinesses(2-19employees)whoreceivehealthinsurancefromtheiremployerstherighttopurchasecontinuationhealthinsuranceaftertheyleave.MinimumEssentialCoverage(MEC):AnyinsuranceplanthatmeetstheAffordableCareActrequirementforhavinghealthcoverage.Examplesofplansthatqualifyinclude:Marketplaceplans;job-basedplans;Medicare;andMedicaid&CHIP.Navigator:Anindividualororganizationthat'strainedandabletohelpconsumers,smallbusinesses,andtheiremployeesastheylookforhealthcoverageoptionsthroughtheMarketplace,includingcompletingeligibilityandenrollmentforms.Theseindividualsandorganizationsarerequiredtobeunbiased.Theirservicesarefreetoconsumers.Network:Thefacilities,providersandsuppliersyourhealthinsurerorplanhascontractedwithtoprovidehealthcareservices.OpenEnrollmentPeriod:Theyearlyperiodwhenpeoplecanenrollinahealthinsuranceplan.OpenEnrollmentfor2020isover,butyoumaystillbeabletoenrollinaMarketplacehealthinsuranceplanfor2020ifyouqualifyforaSpecialEnrollmentPeriod.

You’reeligibleforaSpecialEnrollmentPeriodifyouhavecertainlifeevents,likegettingmarried,havingababy,orlosingotherhealthcoverage.

• Job-basedplansmayhavedifferentOpenEnrollmentPeriods.Checkwithyouremployer.• YoucanapplyandenrollinMedicaidortheChildren'sHealthInsuranceProgram(CHIP)anytime

ofyearOut-of-Network:Thehospitalorproviderdoesnothavecontractwithyourinsurancecompany.Contactyourinsurancecompanyorvisititswebsiteforalistofin-networkhospitalsandproviders.Out-of-PocketCosts:Yourexpensesformedicalcarethataren'treimbursedbyinsurance.Out-of-pocketcostsincludedeductibles,coinsurance,andcopaymentsforcoveredservicesplusallcostsforservicesthataren'tcovered.

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QualifiedHealthPlan(minimumessentialcoverage):Aninsuranceplanthat’scertifiedbytheHealthInsuranceMarketplace,providesessentialhealthbenefits,followsestablishedlimitsoncost-sharing(likedeductibles,copayments,andout-of-pocketmaximumamounts),andmeetsotherrequirementsundertheAffordableCareAct.AllqualifiedhealthplansmeettheAffordableCareActrequirementforhavinghealthcoverage,knownas“minimumessentialcoverage.”Examplesofqualifyinghealthcoverage:

• AnyhealthplanboughtthroughtheMarketplace

• IndividualhealthplansboughtoutsidetheMarketplace,iftheymeetthestandardsforqualifiedhealthplans

• Any“grandfathered”individualinsuranceplanyou’vehadsinceMarch23,2010,orearlier

• Anyjob-basedplan,includingretireeplansandCOBRAcoverage

• MedicarePartAorPartC(butPartBcoveragebyitselfdoesn’tqualify)

• MostMedicaidcoverage,exceptforlimitedcoverageplans

• TheChildren’sHealthInsuranceProgram(CHIP)

• Coverageunderaparent’squalifiedhealthplan

• Moststudenthealthplans(checkwithyourschooltoseeiftheplancountsasqualifyinghealthcoverage)

• HealthcoverageforPeaceCorpsvolunteers

• CertaintypesofveteranshealthcoveragethroughtheDepartmentofVeteransAffairs

• MostTRICAREplans

• DepartmentofDefenseNonappropriatedFundHealthBenefitsProgram

• RefugeeMedicalAssistance

Seeamoredetailedlistoftypesofplansthatdoanddon’tcountasqualifyinghealthcoveragefromtheIRS.

PrimaryCare:Healthservicesthatcoverarangeofprevention,wellness,andtreatmentforcommonillnesses.Primarycareprovidersincludedoctors,nurses,nursepractitioners,andphysicianassistants.Theyoftenmaintainlong-termrelationshipswithyouandadviseandtreatyouonarangeofhealth-relatedissues.Theymayalsocoordinateyourcarewithspecialists.

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PrimaryCareProvider:Aphysician(M.D.–MedicalDoctororD.O.–DoctorofOsteopathicMedicine),nursepractitioner,clinicalnursespecialistorphysicianassistant,asallowedunderstatelaw,whoprovides,coordinatesorhelpsapatientaccessarangeofhealthcareservices.Priorauthorization:Approvalfromahealthplanthatmayberequiredbeforeyougetaserviceorfillaprescriptioninorderfortheserviceorprescriptiontobecoveredbyyourplan.Self-InsuredPlan(Self-FundedPlan):Typeofplanusuallypresentinlargercompanieswheretheemployeritselfcollectspremiumsfromenrolleesandtakesontheresponsibilityofpayingemployees’anddependents’medicalclaims.Theseemployerscancontractforinsuranceservicessuchasenrollment,claimsprocessing,andprovidernetworkswithathird-partyadministrator,ortheycanbeself-administered.SpecialEnrollmentPeriod(SEP):AtimeoutsidetheyearlyOpenEnrollmentPeriodwhenyoucansignupforhealthinsurance.YouqualifyforaSpecialEnrollmentPeriodifyou’vehadcertainlifeevents,includinglosinghealthcoverage,moving,gettingmarried,havingababy,oradoptingachild.

DependingonyourSpecialEnrollmentPeriodtype,youmayhave60daysbeforeor60daysfollowingtheeventtoenrollinaplan.IfyoumissyourSpecialEnrollmentPeriodwindow,youmayhavetowaituntilthenextOpenEnrollmentPeriodtoapply.

YoucanenrollinMedicaidortheChildren’sHealthInsuranceProgram(CHIP)anytimeofyear,whetheryouqualifyforaSpecialEnrollmentPeriodornot.

Job-basedplansmustprovideaSpecialEnrollmentPeriodofatleast30days.

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COVID-19Testing/Treatment*Itemsingreendefinedinglossary

WherecanIfindmoreinformationaboutCOVID-19?ThePennsylvaniaDepartmentofHealthhasadedicatedpageforCOVID-19thatprovidesdailyupdates.Forthemostuptodateinformation,clickhere.IfyouareapatientwhowantstobetestedClickheretovisitthePADepartmentofHealth’swebsiteformoreinformationabouttesting.

WhopaysforCOVID-19diagnostictesting/treatmentifneeded?

GroupHealthPlans,Self-Insured(Self-Funded)PlansandIndividualorGroupCoveragethroughtheMarketplaceLabTesting:ThefederalCentersforDiseaseControlandPrevention(CDC)andthePennsylvaniaDepartmentofHealtharecoveringthecostofthelabtestforthepresenceofCOVID-19performedinfederalorstatelabswhencertainconditionsaremet.ClickheretovisitthePADepartmentofHealth’swebsiteformoreinformation.Inordertohelpcombatthespreadofthevirus,testingincommerciallabshasalsobecomeavailable.Contactyourinsurancecompanytomakesureyourlabisin-networkorchecktoseewhatprovisionstheinsurerhasputinplaceforout-of-networklabwork.Hospitalsandprovidersareexpectedtobillinsurancecompaniesforthefeesassociatedwithcollectingthespecimens,andlabsareexpectedtobillfortheactualtesting.Ifthetestisrecommendedbyyourdoctororotherhealthcareprovider,theFamiliesFirstCoronavirusResponseActrequirescoveragefortheorderofandadministrationofthetestwithnocost-sharingandnopriorauthorizationorothermedicalmanagementrequirementsforprovidervisits(office,urgentcare,ER)includingtelehealth/telemedicine.TreatmentCoverageIncludes:Thesecomprehensivehealthinsuranceplanstypicallyprovidehealthcoverageformedicallynecessarytreatment.Besuretocheckwithyourinsuranceprovidertounderstandhowyourcoverageandcostsharingwillapply.Alsocheckyourhealthinsurancecompany’snetworklistofprovidersandhospitals,and,ifpossible,trytogotoahospitalthatisconsideredin-networkbyyourhealthinsuranceplan.Somehealthplansdonotprovidecoverageforout-of-networkcare,althoughexceptionscanbemadeinuniquecircumstancesincludingemergencies.Ifyouareadmittedintoahospitalformonitoringandobservationyourco-payments,co-insurance,anddeductiblesmayapply.

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TelehealthCoverage:Mostinsurerscovertelehealthforbothmedical(sometimescalledtelemedicine)andbehavioralhealthservices.Checkwithyourinsurertodetermineifco-pays,co-insurance,anddeductibleapplyforCOVID-19treatment.OnMarch10th,2020thePennsylvaniaInsuranceDepartmentreleasedaBulletinnoticeregardingCOVID-19insurancecoverage.Clickheretoview.Inthenotice,theInsuranceDepartmentdiscussestelehealthdeliveryofservices.Itstates:

TelehealthDeliveryofServices.GiventhatCOVID-19isacommunicabledisease,someinsuredsmayprefertousetelehealthservicesinsteadofin-personhealthcareservices.Healthinsurersareencouragedtoreviewtheirrespectiveparticipatingtelehealthserviceproviderarrangements,providecoverageofcostsrelatedtotelehealthservicesandtobepreparedtomeetanyincreaseddemandforthatmeansofdelivery.

MedicareLabTesting:MedicarecoversthelabtestsforCOVID-19withnoout-of-pocketcostsandthedeductibledoesnotapplywhenthetestisorderedbyyourdoctororotherhealthcareprovider.TreatmentCoverageincludes:Medicarealsocoversallmedicallynecessaryhospitalizations.Thisincludesifyou'rediagnosedwithCOVID-19andmightotherwisehavebeendischargedfromthehospitalafteraninpatientstay,butyouneedtostayinthehospitalunderquarantine.WhilethereiscurrentlynovaccineforCOVID-19,ifonebecomesavailable,itwillbecoveredbyallMedicarePrescriptionDrugPlans(PartD).TelehealthCoverage:TypesofVirtualServices:TherearethreemaintypesofvirtualservicesphysiciansandotherprofessionalscanprovidetoMedicarebeneficiaries:Medicaretelehealthvisits,virtualcheck-insande-visits.Currently,Medicarepatientsmayusetelecommunicationtechnologyforoffice,hospitalvisitsandotherservicesthatgenerallyoccurin-person.ForadditionalinformationviewtheMedicareTelemedicineHealthCareProviderFactSheet.Servicespaidthesameasiftheywererenderedface-to-faceforbothbehavioralandphysicalhealth

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MedicareAdvantageLabTestandTreatmentCoverage:IfyouhaveaMedicareAdvantagePlan,youhaveaccesstothesamebenefitsasMedicare.Medicareallowstheseplanstowaivecost-sharingforCOVID-19labtestswithnopriorauthorizationorutilizationmanagementrequirements.

MedicalAssistance(MA)andManagedCareOrganizations(MCOs)LabTesting:ForMedicalAssistance(MA)andMCOs,alllabtests,includingtestsforCOVID-19,arecoveredwithoutcopaymentsorpriorauthorizationTreatmentcoverageincludes:

• X-raysanddiagnostictesting(nopriorauthorizationrequired)• Hospitalcare(inpatientandoutpatient)• EmergencyAmbulanceTransportation• Non-emergencytransportationtoMAcoveredappointments• Homehealthservices• Nursingfacilitycare• Prescriptiondrugs(earlyrefillsandextendedsuppliesnowavailable)• Anymedicallynecessaryserviceforpeopleundertheageof21

TelemedicineCoverage-MedicalAssistance:

Telemedicinepreferredwhenpatientisquarantinedorself-isolating.Patientcanreceiveservicesprovidedthroughtelemedicineathome.Hospitalclinics,outpatientclinics,CRNPs,physicians,physician’sassistants,certifiednursemidwives,andearlyinterventiontherapistscanprovideservicesthroughtelemedicine.Servicemustberenderedinthesamewayitwouldhavebeenin-person.Audio-visualconnectivityisstronglypreferred,buttelephone-onlymaybeusedifA/Visnotavailable.Servicespaidthesameasiftheywererenderedface-to-faceforbothbehavioralandphysicalhealthTelemedicineCoverage-MCOs:MCOsmustoffercoverageforservicesthroughtelemedicinethatmeetsorexceedscoverageunderfee-for-service.ManyMCOsoffermoreexpansivecoverageandhavespecificappsthattheyoffertopatients.MCOshavebeeninstructedtomakenetworkprovidersandenrolleesawareoftheirtelehealthoptions.Forspecificcoverageinformation,pleasecontacttheMedicalAssistancefee-for-serviceprogramifyouonlyhaveanACCESScard,oryourmanagedcareorganizationifyouhaveanotherinsurancecardinadditiontoyourACCESScard.Servicespaidthesameasiftheywererenderedface-to-faceforbothbehavioralandphysicalhealth.

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CommunityHealthChoices(CHC)LabTests:IfyouhaveaCommunityHealthChoicesplan,alllabtests,includingtestsforCOVID-19,arecoveredwithoutcopaymentsorpriorauthorizationTreatmentcoverageincludes:

• X-raysanddiagnostictesting(nopriorauthorizationrequired)• Hospitalcare(inpatientandoutpatient)• EmergencyAmbulanceTransportation• Non-emergencytransportationtoMAcoveredappointments• Homehealthservices• Nursingfacilitycare• Prescriptiondrugs(earlyrefillsandextendedsuppliesnowavailable)• Anymedicallynecessaryserviceforpeopleundertheageof21

*notemostCHCenrolleesareduallyeligible,soMedicareistheprimarypayer.Onlypeopleovertheageof21areenrolledinCHC.TelemedicineCoverage:CHCsfollowtheMedicaretelehealthpolicyTypesofVirtualServices:TherearethreemaintypesofvirtualservicesphysiciansandotherprofessionalscanprovidetoMedicarebeneficiaries:Medicaretelehealthvisits,virtualcheck-insande-visits.Currently,Medicarepatientsmayusetelecommunicationtechnologyforoffice,hospitalvisitsandotherservicesthatgenerallyoccurin-person.ForadditionalinformationviewtheMedicareTelemedicineHealthCareProviderFactSheet.Servicespaidthesameasiftheywererenderedface-to-faceforbothbehavioralandphysicalhealth

PEBTF(PennsylvaniaEmployeesBenefitTrustFund)Labtesting:IfyouhaveaPEBTFplan,theCOVID-19diagnostictestiscoveredwithoutcopaysanddeductibles.ThepolicywillcoverthetestkitformemberswhomeetCDCguidelinesfortestinginanyapprovedlaboratorylocation.Treatmentcoverageincludes:Asacomprehensivehealthinsuranceplans,PEBTFprovideshealthcoverageformedicallynecessarytreatment.Besuretocheckwithyourinsurancecompanytounderstandhowyourcoverageandcostsharingwillapply.Alsocheckyourhealthinsurancecompany’snetworklistofprovidersandhospitals,ifpossible.Trytogotoahospitalthatisconsideredin-networkbyyourhealthinsuranceplan.Some

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healthplansdonotprovidecoverageforout-of-networkcare,althoughexceptionscanbemadeinuniquecircumstancesincludingemergencies.Ifyouareadmittedintoahospitalformonitoringandobservationyourco-payments,co-insurance,anddeductiblesmayapply.TelehealthCoverage:PEBTFcoverstelehealthvisitsandiscurrentlywaivingtheassociatedcost-sharingTolearnmorevisitwww.PEBTF.org

Children’sHealthInsuranceProgram(CHIP)LabTesting:IfyouhaveaplanthroughCHIP,alllabtests,includingtestsforCOVID-19,arecoveredwithoutcopaymentsorpriorauthorizationTreatmentcoverageincludes:

• Physicianservicesincludingsickandurgentcarevisits,house-callsinthephysician’sserviceareaandtelehealthserviceswithafamilypractitioner,generalpractitionerorpediatrician(copayswaived)

• Urgentcareservices.• X-raysanddiagnostictestingwithanorderfromyourPrimaryCarePhysician,specialistor

facilityprovider.• Hospitalcare(InpatientandOutpatient).• Emergencyambulancetransportation• Homehealthandhomeandcommunity-basedhealthcareservices.• Nursingcareservices.• Prescriptiondrugs.• Over-the-countermedicationsforfeverrelief,coughpreparationsaswellasmedicationsrelated

tothetreatmentofvirussymptomswhenprescribedbyyourphysicianandpartoftheCHIPMCO’sformulary.Co-paysmayapply.

TelehealthCoverage:ACHIPManagedCareOrganizationisauthorizedtoutilizetelehealththesameasaphysicianofficevisitforexamination,diagnosisandtreatmentofanillnessprovidedtheserviceisprovidedbythefamilypractitioner,generalpractitionerorpediatrician.

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TRICARE,CoverageforVeterans,andCoverageforFederalCiviliansTRICAREhascreatedalistoffrequentlyaskedquestionsrelatedtoCOVID-19.YoucanvisitTRICARE’swebsitebyclickinghere.Topicsinclude:

• COVID-19Testing• TRICAREHealthPlan• Pharmacyandprescriptions• Quarantine• MTFManagement• MedicalCare

IndianHealthServicesIndianHealthServiceshascreatedinformationrelatedtothefederalresponseinIndianCountry.YoucanvisittheIndianhealthserviceswebpagebyclickinghere.Topicsinclude:

• Generalinformation• Testing• Accesstopersonalprotectiveequipment• Funding• EmergencyPlanning• Servicedeliveryduringapandemic

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CommonQuestions

WhatshouldIdoifIgotabillfortesting?Ifyougetabillfortestingthatyoubelieveisinerror,startbycallingyourdoctor’sofficeandaskifyougotthebillbymistake.DoctorsandinsurancecompanieshavechangedtheirbillingprocessesquicklytorespondtoCOVID-19,andtheremighthavebeenanerror.Ifyourdoctor’sofficecan’tresolvethebill,callthecustomerservicelineforyourhealthcarecoverage.YoucanalsocallthePennsylvaniaInsuranceDepartment’sHelpLineat(877)881-6388.WhatshouldIdoifIhavehealthconcernsthatrequireemergencymedicalservices?NOTE:IndividualswhohavehadCOVID-19symptomsorwhobelievetheymayhavecomeincontactwiththevirus,havenotusuallyneededemergencyservices.

Intheeventemergencymedicalservicesareneeded,however,insurancecarriersmustcoverservicesforanemergencymedicalconditionatin-networklevels.Emergencyservicesincludetransportation,suchasambulanceservices,aswellasinpatientandoutpatienthospitalservicesnecessarytostabilizethepatient.

WhatshouldIdoifIdon'thavehealthinsurance?

Whether you are experiencing symptoms or not, now is a good time to see if you are eligible forenrollmentinhealthinsurancecoverage.Somehealthprograms,likeMedicalAssistance(MA)andCHIPwillenrollyouatanytimethroughouttheyear.Somehealthinsurancecoverage,liketheMarketplace,mayonlybeavailableifthereisaSpecialEnrollmentPeriod.ThePennsylvaniaAssociationofCommunityHealthCenters(PACHC)offersfree,personal,nopressure,noobligation,non-biasedenrollmentassistance.PACHCanditsnetworkofCommunityHealthCentersare available to assist you in navigating and enrolling in the Health Insurance Marketplace, MedicalAssistance(MA),MedicareandCHIP.CertifiedExchangeAssistersareavailablethroughoutPennsylvaniatohelpyouenrollintheseprograms.Hereisalistofexchangeassistersinyourarea.Youcanalsosearchbyusingthefindahealthcenterpage.Ifyouhaveadditionalquestionsorneedfurtherassistance,pleasecontactthePACHC’sNavigatorHubat1-866-944-CARE(2273)YoucanalsouseCOMPASStosignupforMedicalAssistance.COMPASSisanonlinetoolforPennsylvanianstoapplyformanyhealthandhumanserviceprogramslikeMedicaidandCHIP.VisitCOMPASSatwww.compass.state.pa.us.IfyouwouldprefertoresearchsigningupforaMarketplaceplanwithoutassistance,youcanvisitwww.healthcare.govIfyouremainuninsured,theFamiliesFirstCoronavirusResponseActmayprovidecoveragefortheCOVID-19testingadministeredduringemergencyperiodandassociatedvisit.

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WhatshouldIdoifI’vebeenlaidoffandInolongerhavehealthinsurance?

CobracoverageandtheMarketplaceWhenyoulosejob-basedinsurance,youmaybeofferedCOBRA(ConsolidatedOmnibusBudgetReconciliationACT)continuationcoveragebyyourformeremployer.

• Ifyou’relosingjob-basedcoverageandhaven’tsignedupforCOBRA,learnaboutyourrightsandoptionsunderCOBRAfromtheU.S.DepartmentofLaborbyclickinghere.IfyouareentitledtoelectCOBRAcoverage,youmustbegivenanelectionperiodofatleast60days(startingonthelaterofthedateyouarefurnishedtheelectionnoticeorthedateyoucouldlosecoverage)tochoosewhetherornottoelectcontinuation.

• IfyoudecidenottotakeCOBRAcoverageoronceyourCOBRAcoverageperiodends,youmayenrollinaMarketplaceplaninstead.Losingjob-basedcoveragequalifiesyouforaSpecialEnrollmentPeriod.Thismeansyouhave60daystoenrollinahealthplan,evenifit’soutsidetheannualOpenEnrollmentPeriod.Youmayclickheretolearnmoreathealthcare.gov.

Whether you are experiencing symptoms or not, now is a good time to see if you are eligible forenrollmentinhealthinsurancecoverage.Somehealthprograms,likeMedicaidandCHIP,willenrollyouatany time throughout theyear. Somehealth insurancecoverage, like theMarketplace,mayonlybeavailableifyouqualifyforaSpecialEnrollmentPeriod.ThePennsylvaniaAssociationofCommunityHealthCenters (PACHC) offers free, personal, no pressure, no obligation, non-biased enrollmentassistance.PACHCanditsnetworkofCommunityHealthCentersareavailabletoassistyouinnavigatingand enrolling in the Health InsuranceMarketplace,Medical AssistanceMedicare and CHIP. CertifiedExchangeAssistersareavailablethroughoutPennsylvaniatohelpyouenrollintheseprograms.

Hereisalistofexchangeassistersinyourarea.Youcanalsosearchbyusingthefindahealthcenterpage.Ifyouhaveadditionalquestionsorneedfurtherassistance,pleasecontactthePACHC’sNavigatorHubat1-866-944-CARE(2273)YoucanalsouseCOMPASStosignupforMedicalAssistance.COMPASSisanonlinetoolforPennsylvanianstoapplyformanyhealthandhumanserviceprogramslikeMedicaidandCHIP.VisitCOMPASSatwww.compass.state.pa.us.IfyouwouldprefertoresearchsigningupforaMarketplaceplanwithoutassistance,youcanvisitwww.healthcare.govIfyouareuninsured,theFamiliesFirstCoronavirusResponseActmayprovidecoveragefortheCOVID-19testingadministeredduringemergencyperiodandassociatedvisit.

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COBRAQuestionsWhatbenefitsmustbecoveredunderCOBRA?IfyouelecttopurchaseCOBRA,thecoverageshouldbethesameaswhatyouhadwithyouremployercoverageHowlongdoIhavetoelectCOBRACoverage?IfyouareofferedCOBRAcoverage,youmustbegivenanelectionperiodofatleast60days(startingonthelaterofthedateyouarefurnishedtheelectionnoticeorthedateyouwouldlosecoverage)tochoosewhetherornottoelectcontinuationcoverage.WhyisCOBRAcoverageexpensive?COBRAcoverageisexpensivebecauseyouremployerisnolongercontributingtowardsthecost.Youmaywanttocontactalocalexchangeassistertodeterminetoreviewalltheoptionsavailabletoyouforhealthinsurancecoverage.Whatifmycompanyclosedorwentbankrupt?AmIstilleligibleforCOBRA?Ifthereisnolongerahealthplan,thereisnoCOBRAcoverageavailable.If,however,thereisanotherplanofferedbythecompany,youmaybecoveredunderthatplan.Unionmemberswhoarecoveredbyacollectivebargainingagreementthatprovidesforamedicalplanalsomaybeentitledtocontinuedcoverage.DodeductiblesstartoverwithCOBRA?No.Ifyoualreadysatisfiedyourdeductibleandout-of-pocketexpenses,youdonotstartoveragaininthesameplanyear.ForadditionalinformationaboutCOBRAcoverage,clickheretoviewtheU.S.DepartmentofLabor’sCOBRAinformation.ForadditionalinformationaboutthequestionsaboveclickheretoreviewFrequentlyAskedQuestionsaboutCOBRA.

Mini-COBRAWhatis“mini-COBRA”?Mini-COBRA,orAct2of2009,isaPennsylvanialawthatgivesemployeesofsmallbusinesses(2-19employees)whoreceivehealthinsurancefromtheiremployerstherighttopurchasecontinuationhealthinsuranceaftertheyleaveemployment.Itallowseligibleemployeesanddependentstopurchasehealthinsurancethroughtheirformeremployerforninemonthsaftertheiremploymentends,aslongastheirformeremployer’scoverageiscontinued.Whyisitcalled“mini-COBRA”?IsitdifferentfromfederalCOBRA?Mini-COBRAismodeledafterthefederalCOBRAlaw,butwithsomeimportantdifferences.ThefederalCOBRAlawallowsemployeesatlargerbusinesses(20ormoreemployees)topurchasecontinuationhealthcoverageaftertheyleaveemploymentfor18months(or,insomecases,36months)aftertheiremploymentends.Pennsylvania’sMini-COBRAappliestoemployeesofsmallerbusinesses(2-19employees)anditisforashorterlengthoftime(ninemonths,withnoextensions).WhoiseligibleforMini-Cobracontinuationcoverage?

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Coveredemployeesandtheireligibledependentswholosegrouphealthinsurancecoveragethroughasmallemployerasaresultofa“qualifyingevent”areeligibleforMini-COBRAcontinuationcoverage.Thecoveredemployeesandeligibledependentsmusthavebeencontinuouslyinsuredunderthegrouppolicyorforsimilarbenefitsunderanygrouppolicywhichitreplaced,forthreeconsecutivemonthsendingwiththeemployee’stermination.Also,continuationcoverageisnotavailableforanyonewhoiscoveredoriseligibleforcoverageunderMedicare;whofailstoverifythatheisineligibleforemployer-basedgrouphealthinsuranceasaneligibledependent;orisorcouldbecoveredbyanyotherinsuredoruninsuredgrouphealthcoveragearrangementandunderwhichthepersonwasnotcoveredimmediatelypriortosuchtermination(thislastconditionexcludesMedicalAssistanceandCHIP.Whatisa“qualifyingevent”?Aqualifyingeventisaneventthatwouldresultinthelossofcoverageforthecoveredemployeeoreligibledependent,including:

•deathofthecoveredemployee,•terminationofemployment(eithervoluntaryorinvoluntary,butnotfortheemployee’sgrossmisconduct),•reductioninhours,•divorceorlegalseparation,•eligibilityforMedicare,•dependentchildceasingtobedependent,•bankruptcyoftheemployer.

FormoreinformationaboutMiniCOBRAclickhereWhatshouldIdoifmyinsurancewon’tcoverCOVID-19testingortreatment?Ifyouhaveanexceptedbenefitpolicy,short-term,limiteddurationhealthinsurancecoverage,orahealthcaresharingministryplan,theFamiliesFirstCoronavirusResponseActmayprovidecoverageforyourCOVID-19testingasanuninsuredperson.

However,ifyoubelieveyourinsurancecompanyshouldbecoveringCOVID-19testingortreatmentbutisnot,youcanfileacomplaintwiththePennsylvaniaInsuranceDepartment.ThePennsylvaniaInsuranceDepartmentconsumerservicesteamcanbereachedbyvisitinginsurance.pa.govorbyphoneat(877)881-6388.

WhatshouldIdoifIwanttorefillmyprescriptionsearlytohavemoreonhand?ThePennsylvaniaInsuranceDepartmenthasencouragedinsurerstocoverrefillsevenwhenthescheduledrefilldatehasnotbeenreached.(Thisrecommendationdoesnotapplytoprescriptiondrugswithahighlikelihoodofabuse,suchasopioids.)Ifyouarethinkingaboutrequestingadditionalsuppliesofmedication,discussyouroptionswithyourprovider,includingwhetheryourone-monthsupplycanbeincreasedtothree.WiththeCOVID-19pandemic,manyinsurersaregivingconsiderationto90-dayrefills,butyoushouldcontactyourproviderandyourinsurancecompanyifyouhavequestions.MedicarebeneficiariesenrolledinthePACEProgramcanrefillprescriptionspriortousing75%ofthemedication,exceptformedicationswiththepotentialforabuse.WhatshouldIdoifIwanttoreceiveassistanceviatheuseoftelehealthfromaprovideroutsideoftheCommonwealthofPennsylvania?

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GovernorWolfgrantedtheDepartmentofState’srequesttoallowlicensedpractitionersinotherstatestoprovideservicestoPennsylvaniansviatheuseoftelehealth,withoutobtainingaPennsylvanialicense,forthedurationoftheemergency.Out-of-statepractitionersmust:

• Belicensedandingoodstandingintheirhomestate,territoryorcountry.• ProvidethePennsylvaniaboardfromwhomtheywouldnormallyseelicensurewiththe

followinginformationpriortopracticingtelehealthwithPennsylvanianso Theirfullname,homeorworkmailingaddress,telephonenumber,andemailaddress;o Theirlicensetype,licensenumberorotheridentifyinginformationthatisuniquetothe

practitioner’slicense,andthestateorgovernmentalbodythatissuedthelicense.Besuretocheckwithyourinsurancecompanybeforereceivingassistancefromanout-of-stateprovidertofindoutifthatproviderisinyournetworkoriftheserviceswillbecoveredasifin-network.CanmyinsurancecarriercancelorrefusetorenewmyinsurancepolicyifIamdiagnosedwithCOVID-19?Cantheydenymyclaimforapre-existingcondition?HealthinsurersmaynotcancelorrefusetorenewyourindividualorgrouphealthinsurancepolicyifyouarediagnosedwithCOVID-19.Federalandstateregulationsprovideprotectionsagainstpre-existingconditionexclusionsinindividualandgrouphealthinsurancecoverage.Thosepre-existingconditionprotectionsdonotapplytoshort-term,limited-durationhealthinsurancecoverageorexceptedbenefitpolicies.Ifyouhavequestionsorneedassistancerelatedtoyourhealthinsurance,contactthePennsylvaniaInsuranceDepartmentconsumerservicesteamat(877)881-6388.Theconsumerservicesteamisavailabletoanswerquestionsaboutinsurancecoverageandbenefits.TheInsuranceDepartmentmayalsohelpifyoureceiveanunexpectedbillrelatedtoCOVID-19orotherhealthcareservices.WhatshouldIdoifIhaveMedicalAssistanceorCHIPcoverage?IfyouareenrolledinMedicalAssistanceandhavequestionsregardingcoverage,contactyourmanagedcareorganizationortheFeeforServiceRecipientServiceCenterat1-800-537-8862.IfyouareenrolledinCHIPandhavequestionsregardingcoverage,pleasecontactyourCHIPinsurancecompanyorcall1-800-986-KIDS(5437)WhatshouldIdoifIhavequestionsaboutMedicareorCaregiverInquiries?Yes.IfyouhavequestionsregardingMedicarebeneficiariesandcaregiverinquiries,pleasecallCMSat(800)548-9034.

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FederalLegislationWhathasthefederalgovernmentdoneinresponsetotheCOVID-19pandemic?Congresshaspassedthefollowinglegislation:

• FamiliesFirstCoronavirusResponseAct• CoronavirusPreparednessandResponseSupplementalAppropriationsAct,2020

Inaddition,Congressisconsideringadditionallegislationandeconomicstimulusmeasures.

HowdoestheFamiliesFirstCoronavirusResponseActimpactwhatIpay?GroupHealthPlans,Self-Insured(Self-funded)PlansandIndividualorGroupCoveragethroughthemarketplace.

• Requirescoverageoftestingwithnocost-sharingandnopriorauthorizationorothermedicalmanagementrequirements

§ Providervisits(office,urgentcare,ER)includingtelehealth,thatresultinorderoradministrationofthetest

§ Mustrelatetofurnishingoradministrationofthoseproducts,orevaluatingneedfortheproducts

§ ThetestmustbemedicallynecessaryforCOVID-19.

Medicare• Providesfor100%ofpaymentforCOVID-19testingwithnocostsharingandthedeductible

doesnotapply

MedicareAdvantageProgram• Providesforcoverageofclinicaldiagnosticlabtestsduringtheemergencywithnocostsharing

andnopriorauthorizationorutilizationmanagementrequirements

MedicalAssistance(Medicaid)• Providesforcoverageoftestingandmedicalvisitrelatedtotesting“forwhichpaymentmaybe

madeundertheStateplan”withnocost-sharing

CHIP• Providescoveragefortestingwithnocost-sharing

TRICARE,CoverageforVeterans,andCoverageforFederalCivilians

• Providescoveragefortestingwithnocost-sharingforTriCare,VA,andFederalCivilians

IndianHealthServices

• Providescoveragefortestingwithnocost-sharingforIndiansreceivingcarethroughIndianHealthService

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Scams

Duringthistimeofsocialdistancing,Pennsylvaniansarespendingmoretimeontheirphonesandcomputersforhome,work,shoppingandentertainment.Cybercriminalstakeadvantageofwidespreadfear,panicandworry.Theymayuseyourextrascreentimeandtimeathomeasanopportunity.

Protectyourselfbybeingawareofdifferenttypesofscams.

AccordingtotheU.S.DepartmentofJustice,theFederalTradeCommission(FTC)andtheFederalCommunicationsCommission(FCC),thereareseveralwaysscammerswilluseCOVID-19totargetpeople.

• Vaccineandtreatmentscams.Scammersmayadvertisefakecures,vaccinesandadviceonunproventreatmentsforCOVID-19.ScammersmayevengodoortodoorclaimingtobefromtheCDC(CentersforDiseaseControlandPrevention)offeringyoutheopportunitytobepartofavaccineprogram.Unfortunately,todate,thereisn’tavaccineforCOVID-19andtheCDCisn’tofferingsuchaprogram.

• ShoppingScams.Scammersmaycreatefakestores,e-commercewebsites,socialmediaaccounts,andemailaddressesclaimingtosellmedicalsuppliescurrentlyinhighdemand.Suppliesmightincludethingslikehandsanitizer,toiletpaperandsurgicalmasks.Scammerswillkeepyourmoneybutneverprovideyouwiththemerchandise.

• Medicalscams.ScammersmaycallandemailpeoplepretendingtobedoctorsandhospitalsthathavetreatedafriendorrelativeforCOVID-19anddemandpaymentfortreatment.

• Charityscams.ScammerssometimesaskfordonationsforpeopleandgroupsaffectedbyCOVID-19.• PhishingandMalwarescams.DuringtheCOVID-19crisis,phishingandmalwarescamsmaybeused

togainaccesstoyourcomputerortostealyourcredentials.• Malwareismalicioussoftwaresuchasspyware,ransomware,orvirusesthatcangainaccessto

yourcomputersystemwithoutyouknowing.Malwarecanbeactivatedwhenyouclickonemailattachmentsorinstallriskysoftware.

• WhenPhishingisused,badactorssendfalsecommunicationsfromwhatappearstobeatrustworthysourcetotrytoconvinceyoutosharesensitivedatasuchaspasswordsorcreditcardinformation.

• Forexample,scammersmayposeasnationalandglobalhealthauthorities,includingtheWorldHealthOrganization(WHO)andtheCentersforDiseaseControlandPrevention(CDC)andsendphishingemailsdesignedtotrickyouintodownloadingmalwareorprovidingyourpersonalandfinancialinformation.

• Appscams.ScammersmaycreatemobileappsdesignedtotrackthespreadofCOVID-19andinsertmalwareintothatapp,whichwillcompromiseusers’devicesandpersonalinformation.Besuretouseonlytrustedsources.YoushouldvisittrustedresourcessuchasthePennsylvaniaDepartmentofHealthatwww.health.pa.govortheCDCatwww.CDC.gov.

• Investmentscams.Scammersmayofferonlinepromotionsonthingslikesocialmedia,claimingthatproductsorservicesofpubliclytradedcompaniescanprevent,detect,orcureCOVID-19,causingthestockofthesecompaniestodramaticallyincreaseinvalueasaresult.

(Source:U.S.DepartmentofJusticeandthePennsylvaniaInsuranceDepartment)

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HerearesomeDO’sandDON’TswhenitcomestofindingCornavirus(COVID-19)Scams:

DO:• DOwatchoutforvaccinationsandhometestkitsoffers.Therearecurrentlynovaccines,pills,potions,

lotions,lozengesorotherprescriptionorover-the-counterproductsavailabletotreatorcureCOVID-19• DOwatchforemailsclaimingtobefromtheCentersforDiseaseControlandPrevention(CDC)or

expertssayingtheyhaveinformationaboutthevirus.Forthemostup-to-dateinformationabouttheCoronavirus,visittheCentersforDiseaseControlandPrevention(CDC),theWorldHealthOrganization(WHO)orthePennsylvaniaDepartmentofHealth

• DObecarefulwhileshoppingonline.IfyouseesomeonesellingTHEin-demandproducts,liketoiletpaper,medicalsuppliesorcleaningsupplies,theymaynothaveit.

• DOyourhomeworkwhendonatingtoacharity.Don’tletanyonerushyouintomakingadonation.Ifsomeonewantsdonationsincash,bygiftcard,orbywiringmoney,don’tdoit.

DON’T• DON’Tbelieveeverythingyoureadontheinternet.DON’Tshareinformationthathasn’tbeenverified.

Beforeyouhitsend,makesuretheinformationisaccurateandfromatrustedsource.• DON’Tclickonlinksfromsourcesyoudon’tknow.Theycoulddownloadvirusesontoyourcomputeror

device.• DON’Trespondtoatextoremailaboutchecksfromthegovernment.Thedetailsarestillbeingworked

out.Anyonewhotellsyoutheycangetyouthemoneynowisn’ttellingthetruth.• DON’Tfeeltheneedtoanswerrobocalls.Justhangup!DON’Tpressanynumbers.Scammersareusing

illegalrobocallstosellanythingfromCoronavirustreatmentstowork-at-homeschemes.Eveniftherecordingsaysyouwillspeaktoaliveoperatororbeaddedtothedonotcalllist,DON’Tpressthenumberbutitmightleadtomorerobocalls.

(source:FederalTradeCommissionandthePennsylvaniaInsuranceDepartment)PriceGouging-TheOfficeofAttorneyGeneral’snewtoolisavailabletoeveryoneintheCommonwealth,effectiveimmediately.Anyinstanceofpricegougingshouldbereportedtopricegouging@attorneygeneral.gov.

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WheretogoforHelp:Ifyouhaveindividual,smallgroupemployer,orlargegroupemployercoverage:ThePennsylvaniaInsuranceDepartmentWeb:www.insurance.pa.govPhone:1-877-881-6388or717-783-3898Ifyouhaveemployerself-insuredcoverage: TheUnitedStatesDepartmentofLaborWeb:www.dol.gov/EBSAOpensInANewWindowPhone:1-866-275-7922IfyouhaveMedicarecoverage:MedicareWeb:www.medicare.govOpensInANewWindowPhone:1-800-MEDICAREIfyouhavePennsylvaniaMedicalAssistance(Medicaid): ThePennsylvaniaDepartmentofHumanServicesWeb:www.healthchoicespa.comPhone:1-866-550-4355IfyouhaveChildren'sHealthInsuranceProgram(CHIP)coverage:Pennsylvania'sChildren'sHealthInsuranceProgramWeb:www.chipcoverspakids.comPhone:1-800-986-KIDS(5437)

IfyouhaveStateVeteransServices

ContactyourCountyDirectorofVeteransAffairstodiscussbenefitsandeligibility,thenearestofficeoftheDepartmentofMilitaryandVeteransAffairsorvisitwww.dmva.pa.gov.

PaLinktoAgingandDisabilityServices

PALinkpartnersworktogethertoconnectindividualswithallavailableresourcesrelatedtocare,medication,nutrition,insurance,housing,transportation,employment,behavioralhealthservices,andothersupportsregardlessofanindividual’sage,physicalordevelopmentaldisability,orabilitytopay.TocontactPALink,call800-753-8827onweekdaysfrom9a.m.until5p.m.oremailcarelink@pa.gov.

OlderAdultscanalwayscontacttheirlocalAreaAgencyonAgingforservicesandsupportsintheirarea.

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AdditionalMedicareInformationMEDICAREPARTA–HOSPITALINSURANCEBenefits:MedicarePartAhelpspayfor:

• Inpatienthospitalcare• Inpatientskillednursingfacilitycare• Homehealthcare• Hospicecare• InpatientcareinareligiousnonmedicalhealthcareinstitutionInmostcasesthereisno

premiumforMedicarePartA,howeverifyouarenoteligibleforfreePartAandyoudidn’tbuyitwhenyouwerefirsteligible,yourmonthlypremiummaybehigher.

MEDICAREPARTB–MEDICALINSURANCEBenefits:MedicarePartBhelpspayfor:

Doctor’sservices:

• Outpatienthospitalservices• Variousmedicalservicesandsupplies• PreventativebenefitsAmonthlypremiummustbepaidforPartB.

MEDICAREPARTD–PRESCRIPTIONDRUGCOVERAGEBenefit:MedicarePrescriptionDrugCoverageisavailabletoeveryonewithMedicareandisprovidedbyprivateinsurancecompanies.Youchoosetheplanandpayamonthlypremium.Someplansmayalsohaveadeductibleandothercost-sharessuchasco-paysorco-insurance,however,someindividualsmayqualifyforhelpwiththesecoststhroughtheSocialSecurityAdministration’sLow-IncomeSubsidyalsoknownasExtraHelp.

AdditionalMedicareAdvantageProgramInformation

MedicareAdvantageProgram

• Providesforcoverageofclinicaldiagnosticlabtestsduringtheemergencywithnocostsharingandnopriorauthorizationorutilizationmanagementrequirements

• TheAPPRISEProgramprovidesfree,objective,in-personortelephoneassistancetohelpguideMedicarebeneficiariesthroughtheirmanyhealthinsuranceoptionsincludingMedicareandMedicaid,Medicaresupplementinsuranceplans,MedicareAdvantagePlans,Medicareprescription(PartD),long-termcareinsurancepolicies,andpublic47benefitprograms.Contact:TheAPPRISEProgramat800-783-7067from9a.m.to4p.m.Monday-Friday.

HEALTHYHORIZONS

Toensureadequatehealthcareforlow-incomeseniorsandindividualswithdisabilitiesandallowthemmorespendableincomebypayingtheirMedicarepremiums,thestatedevelopedaspecialMedicalAssistanceprogram–HealthyHorizons.ContactyourlocalDepartmentofHumanServicesCountyAssistanceOfficeorcall(800)692-7462from9a.m.until4:30p.m.Monday-Friday

PACEANDPACENET

ThePharmaceuticalAssistanceContractfortheElderly(PACEandPACENET)programsoffercomprehensiveprescriptioncoveragetoqualifiedolderPennsylvanians.Theprogramscovermostmedicationsthatrequireprescriptions,includinginsulinandinsulinsyringes.PACEorPACENETwrap

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aroundMedicarePartDprescriptioncoverage,supplementingthiscoveragetoofferolderPennsylvaniansthebest70benefitsofbothprograms.Olderadultscontinuetoreceivethesameprescriptionbenefitswhile,inmanycases,theysavemoremoney,andoftenhave$0co-pays.

PACE/PACENETprovidesaone-monthsupplyofmedicationforasmallco-pay.

•ForPACE,$6foreachgenericand$9foreachbrand-nameprescriptiondrug

• AsofMarch5,2020,PACEwillnowreimburseprescriptionrefillseventhoughtherequired75%ofthedays'supplyhasnotpassed–exceptforopioidsandothercontrolledsubstances–whichwillbehandledonacasebycasebasis.EnrolleeswishingtoreceivethatexceptionmusthavetheirpharmacyprovidercontactPACEat1-800-835-8040,24hoursaday,sevendaysaweek,tomakethatrequest.Theprogramhastraditionallynotofferedthisexceptionunlessanenrollee'smedicationswerelostorstolen.Enrolleeswhohavedifficultiesobtainingtheirrefillscancallcardholderservicesat1-800-225-7223

•ForPACENET,$8foreachgenericand$15foreachbrandnameprescriptiondrug

•ForPACE,theProgrampaysMedicarePartDpremiumsifcardholderisenrolledinapremiumpaymentplan.

•ForPACENET,thecardholderisresponsibleforpayingthemonthlypremium.

FindenrollmentapplicationsonlineatPACECares.magellanhealth.com

Formoreinformation,call866-712-2060

PENNSYLVANIAPATIENTASSISTANCEPROGRAMCLEARINGHOUSE

PennsylvaniaPatientAssistanceProgramClearinghouse(PAPAP)assistsanyoneneedingprescriptionhelp,regardlessofincome.Ifyouareuninsured,under-insured,overtheageof18anddonotcurrentlyhaveMedicaidorPACEcoverage,PAPAPwillhelpyouapplyforprescriptionassistancethroughvariouspatientassistanceprogramsthatyoumaynothaveknownabout.Contact:Formoreinformation,call800-955-0989.

PENNSYLVANIAPRESCRIPTIONPRICEFINDER

OnthePriceFinderwebsite,consumersshopforthebestmedicationpricesforcommonlyuseddrugs.Thewebsiteincludesprices,pharmacylocation,storehours,wheretofindlow-costgenerics,anddrugeducationmaterials.Contact:Formoreinformation,call800-835-4080orvisitwww.parxpricefinder.com.