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January 26, 2022

Most insurers must cover free at-home Covid-19 tests. Why not Medicare?

Daily Briefing

    Despite older Americans' increased vulnerability to Covid-19, the Biden administration's new requirement that insurers cover the costs of at-home Covid-19 tests does not apply to Medicare beneficiaries. Writing for Kaiser Health News, Michelle Andrews explains why Medicare doesn't cover these tests and discusses several ways beneficiaries can access the tests for free.

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    Why Medicare doesn't cover at-home Covid-19 tests

    Under the new guidance released earlier this month by HHS, the Department of Labor, and the Treasury Department, private insurers must cover the cost of up to eight at-home rapid Covid-19 tests every month for their plan members.

    However, the rule does not apply to Medicare beneficiaries, since the laws that govern traditional Medicare don't allow for coverage of self-administered diagnostic tests such as Covid-19 rapid antigen tests.

    The services covered under the Medicare program are laid out in federal law, Andrews writes. "It generally excludes over-the-counter things," said Casey Schwarz, senior counsel for education and federal policy at the Medicare Rights Center.

    And while Medicare does cover rapid antigen or PCR testing done by a lab, beneficiaries are limited to one test per year without a doctor's order.

    Some lawmakers have urged the Biden administration to expand Medicare coverage to pay for at-home tests, particularly as it has changed other Medicare rules during the pandemic, such as expanding access to telehealth services. However, since at-home tests seem to fall within coverage gaps, "there's a little bit of a question of where this type of benefit would fit," Schwarz said.

    "While at this time original Medicare cannot pay for at-home tests, testing remains a critical tool to help mitigate the spread of Covid," a statement from CMS said.

    How Medicare beneficiaries can access free Covid-19 tests

    For now, there are several other ways Medicare beneficiaries can access free Covid-19 tests.

    Currently, Medicare beneficiaries can access more than 10,000 free pharmacy testing sites around the nation.

    In addition, the Biden administration recently launched a website where anyone—including Medicare beneficiaries—can order no-cost at-home Covid-19 tests. Eventually, one billion tests will be available through the program, but for now, each residence will only be allowed to receive four tests.

    "Four tests is not a lot of tests," said Juliette Cubanski, deputy director of the program on Medicare policy at the Kaiser Family Foundation. "This is one of the most at-risk populations, and to not have the opportunity to buy at-home tests and get reimbursed puts this whole population on their back foot."

    The Biden administration will also provide up to 50 million additional free at-home tests through community health centers and Medicare-certified health clinics. However, David Lipschutz, associate director and senior policy attorney at the Center for Medicare Advocacy, argued that 50 million tests wouldn't even be enough to provide just one test to all 62 million Medicare beneficiaries.

    For the roughly 4 in 10 Medicare beneficiaries enrolled in Medicare Advantage managed-care plans, their private plans may offer no-cost at-home tests—although it is not required.

    And advocates are holding on to hope that with the expansion of the public health emergency, CMS could still expand coverage of at-home tests.

    "We know that the Medicare program has significant flexibility relative to the public health emergency, and it has demonstrated it has the ability to alter the rules," Lipschutz said. "We think they should find the flexibility to offer the Covid at-home tests for free."

    "This is all a moving target," Lipschutz said. (Andrews, Kaiser Health News, 1/24)

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