Coverage for COVID-19 Testing: A Medicare Customer Question – ThinkAdvisor
What You Need to Know
The government will pay for eight OTC tests for Medicare enrollees.
That will affect both original Medicare and Medicare Advantage enrollees.
Medicare Advantage plans can choose whether to pay for additional OTC tests.
As of January 2022, private health insurance companies are required to cover the over-the-counter coronavirus tests at up to $12 per test. Consumers can either purchase the testing kits at no cost or submit receipts for reimbursement from the insurance company.
The Biden-Harris administration issued this federal mandate to insurance companies as a means to increase nationwide access to rapid tests in efforts to monitor and combat the COVID-19 virus.
The Question:
Does Medicare pay for rapid at-home COVID-19 tests?
The Answer:
Not yet, but it will. The initial federal announcement about testing kits only applied to individuals who held private health insurance policies, and it excluded Medicare coverage for at-home testing. After concerns from many Medicare recipients, including individuals with disabilities and elderly, the government has reversed this position. Starting in the spring, Original Medicare and Medicare Advantage enrollees will be eligible to receive over-the-counter (OTC) COVID-19 tests at no cost to them. Under the new initiative, Medicare will make payments directly to pharmacies, covering the cost of up to eight at-home tests per month and allowing recipients to pick up tests at their convenience.
Until this plan goes into effect, people with Medicare can access free coronavirus testing through other channels, including:
Requesting up to four free rapid tests for home delivery.
Finding a health center or pharmacy in your locality that offers low or no-cost community COVID-19 testing.
Getting a lab-based PCR or antigen test at no cost when the test is ordered by a healthcare professional like a physician or pharmacist. Medicare beneficiaries can also access one lab-performed test without an order, and without cost-sharing, during a public health emergency.
Medicare Advantage plans can choose to pay for at-home COVID-19 tests, but they are not required to do so. Medicare beneficiaries can check with their plan to see what the plan offers, until they can obtain them free from pharmacies. For more information, beneficiaries can consult CMS’ frequently asked questions page, or call 1-800-Medicare.
Bethany Cissell is a health care insurance services specialist at Allsup.
