Medicare Doesn’t Cover At-Home COVID Tests, but Political Pressure for a Policy Change is Mounting

The push by federal and state governments to get in-home COVID tests into the hands of most Americans has been all over the news lately. The effort is unprecedented, as tens of millions of people can expect their test kits to start arriving any day (unless they already have). But there’s one group conspicuously left out of the free-test-kit offer: Medicare beneficiaries. The oversight seems inexplicable to us.

We found this CNBC story about the topic in which reporter Sarah O’Brien explains how those on Medicare can still get free test kits. But we also found other articles that explain how the lack of Medicare coverage is causing major pushback and triggering a loud Congressional clamor for a rapid policy change.

Insurance Mandate Doesn’t Include Medicare

“You may have discovered that Medicare doesn’t cover the cost of at-home COVID tests,” O’Brien states. And if you’re surprised by that, you’re not alone.

Medicare covers a huge portion of the nation’s population. “About 63.3 million people are enrolled in Medicare,” says O’Brien. “Most of the beneficiaries, 55.1 million, are age 65 or older, and the rest are generally younger with permanent disabilities.”

Free COVID tests are available for beneficiaries through other means, but the surprising exemption of Medicare (even some Advantage Plans) from the presidential mandate that “private insurers cover the cost of at-home tests — up to eight per enrollee per month”, has a lot of people scratching their heads. Juliette Cubanski, Medicare policy deputy director at Kaiser Family Foundation, calls it a “major sticking point”, and adds, “It’s a sore spot for Medicare beneficiaries, who are among the highest at risk when it comes to COVID.”

Private Insurance Carriers Must Cover Test-Kit Costs

O’Brien explains, “The Biden administration’s mandate, which took effect January 15, means most consumers with private health coverage can buy an at-home test at a store or online and either get it paid for upfront by their insurer or get reimbursed by submitting a claim to their plan.”

The exemption of Medicare, O’Brien says, comes down to “the specific legal authority used to implement” the presidential directive. And while that doesn’t make anything much clearer, the good news is that free at-home tests are available for beneficiaries despite the exemption, though you may have to seek them out.

“For starters,” O’Brien says, “you can order four for free through COVIDtests.gov, a new government website that officially launched Wednesday. The site, which is available to all households, requires you to provide only your name and address; no insurance information is needed.”

Some Medicare Clinics Running Out of Test Kits

Aside from the four available through the government website, O’Brien highlights Medicare-certified clinics and community health centers as likely places to pick up free tests. But Cubanski cautions, “given that demand for the tests is generally outpacing supply, those facilities may also be struggling to maintain inventory.”

Medicare Advantage Plan beneficiaries are encouraged to check with their individual plans to find out if they cover at-home tests. Some do, and some don’t. “It could be covered as a supplemental benefit but not a requirement,” Cubanski says, and adds, “And, of course, beneficiaries can still access free testing outside their home.”

Lab testing at 20,000 free testing sites nationwide is still available to everyone regardless of insurance, and is highly recommended as a key way of mitigating COVID’s spread. O’Brien says, “Also, if a doctor or other authorized health-care provider orders it, there is no cost-sharing for the test. Otherwise, beneficiaries are allowed to get one lab test for free per year without a doctor’s order.”

Will Medicare ever pay for at-home tests? The future is uncertain. “It would likely take congressional action to allow it,” Cubanski says. “But I have not heard any public discussion about making that happen.”

Advocacy Group Puts Pressure on Policy-Makers

However, the folks at the Center for Medicare Advocacy are saying a loud “Wait a minute!” to federal officials. In this press release from last week, the CMA notes that, 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. As a result, says CMA, “advocates and policymakers are urging CMS to find a way to cover such tests for all Medicare beneficiaries.”

Many members of Congress have stepped up loudly to address the issue, urging the Administration to take action.  One example, reported on the website MedPage Today, is a letter sent by eight Senate Democrats to HHS Secretary Xavier Becerra and others at the Center for Medicare and Medicaid Services. “Seniors and people with disabilities enrolled in Medicare are at the highest risk of severe illness from COVID-19, and people over 65 account for nearly three-quarters of all deaths from the virus,” the lawmakers wrote. “The current policy leaves them on the hook for potentially significant out-of-pocket costs.” The Senators added that they “look forward to working with [officials] to address this issue.” 

The Center for Medicare Advocacy has joined 70 other groups, according to the CMA press release, in “urging the Administration to do more to provide equitable access to at-home tests and vaccines for older adults and individuals with disabilities.”  In response, officials at 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’ll watch this developing story and keep readers apprised of any policy changes.

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(originally reported at www.cnbc.com and other sources)