Photo: Violeta Stoimenova/Getty Images
People covered either by original Medicare or Medicare Advantage will be able to get over-the-counter COVID-19 tests at no cost starting in early spring.
Under the new initiative, Medicare beneficiaries will be able to access up to eight over-the-counter COVID-19 tests per month for free. Tests will be available through eligible pharmacies and other participating entities. This policy will apply to COVID-19 over-the-counter tests approved or authorized by the U.S. Food and Drug Administration.
WHY THIS MATTERS
This is the first time that Medicare has covered an over-the-counter test at no cost to beneficiaries.
The federal government announced last month that it was requiring insurance companies and group health plans to cover the cost of over-the-counter at-home COVID-19 tests for people with private health insurance.
There are a number of issues that have made it difficult to cover and pay for over-the-counter COVID-19 tests, according to the Centers for Medicare and Medicaid Services. However, given the importance of expanding access to testing, CMS said it has identified a pathway that will expand access to free over-the-counter testing for Medicare beneficiaries.
This new initiative will enable payment from Medicare directly to participating pharmacies and other participating entities to allow Medicare beneficiaries to pick up tests at no cost. CMS anticipates that this option will be available to people with Medicare in the early spring.
Until then, people with Medicare can access free tests through a number of channels by: Requesting four free over-the-counter tests for home delivery at covidtests.gov; accessing tests through healthcare providers at more than 20,000 free testing sites nationwide; and accessing lab-based PCR tests and antigen tests performed by a laboratory when the test is ordered by a physician, non-physician practitioner, pharmacist, or other authorized healthcare professional at no cost.
In addition to accessing a COVID-19 lab test ordered by a healthcare professional, people with Medicare can also already access one lab-performed test without an order, also without cost sharing, during the public health emergency, CMS said.
Medicare Advantage plans may offer coverage and payment for over-the-counter COVID-19 tests as a supplemental benefit in addition to covering Medicare Part A and Part B benefits.
All Medicare beneficiaries with Part B are eligible for the new benefit, whether enrolled in a Medicare Advantage plan or not.
THE LARGER TREND
As the Omicron virus surged, finding rapid, at-home tests at the pharmacy proved challenging and there were long lines at testing sites.
As testing determines infection, a positive test resulting in self-quarantine can prevent the coronavirus from spreading to others.
Production of rapid tests, including at-home tests, has increased because of funding from the Defense Production Act. There are now at least eight at-home tests on the market.
Email the writer: [email protected]