Medicare Member Plan Benefits Resume for Applicable COVID-19 Testing, Screening, and Treatment Services on May 12, 2023

Date: 05/31/23

Earlier this year, the Biden Administration announced that the federal Public Health Emergency (PHE) related to the COVID-19 pandemic will end on May 11, 2023.

During the PHE, we followed guidance from the Centers for Medicaid & Medicare Services (CMS) and instituted temporary waivers for select services. This action ensured that critical care could be quickly delivered to our members during a time of heightened need. Beginning May 12, 2023, these temporary waivers will expire, and our members’ Medicare plan benefits will be reinstated for the following services:

Service	Member Liability	Prior Auth Needed?
COVID-19 Testing and Screening (Administered by Provider)	Per member plan benefits	No
COVID-19 Vaccinations	$0 member cost-share for vaccine administration*	No
COVID-19 Monoclonal Antibody Treatments	$0 member cost-share for treatment administration*	Prior authorization only required for CPT code Q0221

*Vaccine ingredient cost is still covered directly by Medicare FFS.

Alongside these waivers, the Coronavirus Aid, Relief, and Economic Security (CARES) Act provided for a 20% increase to the inpatient prospective payment system (IPPS) Diagnosis Related Group (DRG) rate for COVID-19 patients for the duration of the public health emergency. This increase applied to claims that included the applicable COVID-19 ICD-10-CM diagnosis code and met the date of service requirement. When the PHE ends on May 11, 2023, these add-on payments will no longer be included for discharge dates of service as of May 12, 2023 and thereafter.

Wellcare is committed to providing a smooth transition for both our members and providers as we resume business as usual. While we will continue to communicate any updates to our business