Highmark Medicare waives co-pays for COVID inpatient hospital care in 2021

In preparation for its Medicare product rollout for 2020, Highmark Health ensured that it had the infrastructure to allow all of its Medicare consumers the ability to receive care through telehealth.

That foresight proved beneficial for the Pittsburgh-based insurer when the pandemic made it nearly impossible for most Medicare-eligible patients to receive in-person physical care.

With the framework already set to pay providers for their telehealth services in place, Highmark waived all of the costs for telehealth for its Medicare customers during the pandemic to ease the transition away from physical care.

The system was only able to enact those changes in the same year thanks to a series of regulatory rollbacks from the Centers for Medicare and Medicaid Services.

For 2021, Highmark plans to continue to offer zero copay for all primary care visits, but will revert back to its previous cost-sharing amount with specialty care physicians, said Ellen Galardy, vice president of market strategy for Medicare markets at Highmark Health.

“Our strategy was to make sure that for COVID we covered all services,” said Galardy. “In 2020 we felt like we had to give a push to help people try telehealth for the first time. What we saw was almost all of that was primary care visits.”

Last week, Highmark revealed its Medicare Advantage products for next year. Galardy said the 2021 series of products were greatly affected by the pandemic, with Medicare-eligible customers having access to testing and vaccinations at no charge. The insurer also waived copay for inpatient hospitalizations related to COVID-19 for part of 2020 but will now be waiving copay for the entire year.

“With the advent of COVID, not only was Highmark one of the first to waive the cost of inpatient stays for COVID, we took steps early this spring to file for 2021 as well,” Galardy said. “We hoped that this would be behind us but we were proactive to make sure that our members didn’t need to worry if they found themselves in that situation.”

In anticipation for Medicare’s open enrollment period from October 15 to December 7, Galardy said Highmark has prepared its health care stores in Easton, Lancaster and Harrisburg to adhere to social distancing guidelines knowing that many of its customers feel more comfortable going to third-party locations rather than have a sales person come to their homes.

Galardy added that despite the preparations, many customers may decide to wait another year before choosing a Medicare product.

“Highmark is taking every bit of care to make (shopping in the COVID environment) safe and we are waiting to see if even more people will be looking or if they will delay shopping for a product for another year,” she said. “You see some people respond to COVID by sitting tight.”