On January 10, 2022, the Biden Administration announced a requirement that, starting January 15, insurance companies and group health plans must cover the cost of over-the-counter, at-home COVID-19 tests. The administration is also taking additional steps to expand access to free at-home tests, as described in an FAQ document issued by the Centers for Medicare & Medicaid Services (CMS).
As noted in the FAQ document, however, while Medicare beneficiaries can take advantage of the free at-home tests available to the general public, traditional Medicare will not generally cover such tests, and Medicare Advantage plans can cover them at their discretion:
14. I’m covered by Medicare. How do I get an at-home over-the-counter COVID-19 test?
HHS is providing up to 50 million free, at-home tests to community health centers and Medicare-certified health clinics for distribution at no cost to patients and community members. You can learn more about this program here. HHS also has established more than 10,000 free community-based pharmacy testing sites around the country. To respond to the Omicron surge, HHS and FEMA are creating surge testing sites in states across the nation. The Biden-Harris Administration is purchasing 500 million at-home, over-the-counter tests to be distributed for free to Americans who want them, with the initial delivery starting in January 2022. There will be a website where all Americans can request at-home tests for home delivery—for free. More information on this federal program is expected soon.
For people covered by original fee-for-service Medicare, Medicare pays for COVID-19 diagnostic tests performed by a laboratory, such as PCR and antigen tests, with no beneficiary cost sharing when the test is ordered by a physician, non-physician practitioner, pharmacist, or other authorized health care professional. People with Medicare can access one lab performed test without cost sharing per patient per year without an order. At this time original Medicare cannot pay for at-home tests through this program. Medicare Advantage plans may offer coverage and payment for at-home over-the-counter COVID-19 tests, so consumers covered by Medicare Advantage should check with their plan. [emphasis added]
As noted in a Kaiser Health News article by Michelle Andrews (Jan. 24, 2022), advocates and policymakers are urging CMS to find a way to cover such tests for all Medicare beneficiaries. Members of Congress have recently sent letters urging the Administration to take action. For example, on January 14, 2022, Rep. Bill Pascrell and Rep. Scott Peters sent a letter; on January 20, 2022, Rep. Tom Malinowski and Rep. Kim Schrier led a bipartisan letter with over 100 members signing on; and, on January 24, 2022, Senator Debbie Stabenow and 18 other senators sent a letter. On January 24, 2022, the Center for Medicare Advocacy joined almost 70 other organizations in signing on to a letter led by our colleagues at Justice in Aging and Medicare Rights Center urging the Administration to do more to provide equitable access to at-home tests and vaccines for older adults and individuals with disabilities.
According to a Bloomberg Law article by Jeannie Baumann (Jan. 26, 2022), CMS “confirmed in a statement […]that it ‘is exploring ways that Medicare can cover them as we look to overcome a number of statutory and regulatory hurdles.’”
We urge the Administration to act quickly.