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News Update: In a Significant Policy Reversal, Medicare Will Begin Covering Cost of At-Home COVID Tests Later This Spring

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Just last week here on the AgingOptions blog, we shared a perplexing report that – for reasons best known to federal policy-makers – the free in-home COVID test kits being offered to insurance beneficiaries across America were not going to be offered to the one group in greatest need: those on Medicare. “There’s one group conspicuously left out of the free-test-kit offer: Medicare beneficiaries,” we wrote. “The oversight seems inexplicable to us.”

As our blog article explained, the pushback from Congress and from senior advocacy groups began immediately. This week, we’re glad to report – surprisingly – that all the angry response has already borne fruit. In this CNBC update, written by reporter Sarah O’Brien, we learn that the federal government has officially reversed course.

CMS Announces a Rapid Policy About-Face

As CNBC reported, “Medicare beneficiaries will be able to get free at-home COVID tests beginning early this spring, the government announced Thursday.” This press release from the Centers for Medicare and Medicaid Services outlined the policy change.

“This is the first time that Medicare has covered an over-the-counter test at no cost to beneficiaries,” the CMS announcement stated. The agency cited unspecified difficulties in paying for over-the-counter COVID-19 tests. “However,” CMS added, “given the importance of expanding access to testing, CMS has identified a pathway that will expand access to free over-the-counter testing for Medicare beneficiaries.”  Considering the pressure that they were under, that’s not necessarily a surprise.

Medicare Beneficiaries Would Have Faced Higher Costs for Test Kits

This about-face has real impact on the populations most at-risk for COVID. O’Brien explains, “About 63.3 million people are enrolled in Medicare. Most of the beneficiaries, 55.1 million, are age 65 or older, and the balance are generally younger with permanent disabilities.”

It came as a shock to many, then, that Medicare was left out of the original Biden administration mandate that up to eight over-the-counter COVID tests per month per enrollee be covered by private insurers. “Retail prices for over-the-counter at-home COVID tests can range from as little as $10 to hundreds of dollars,” O’Brien writes. “Tests at laboratories can run considerably more.” The change in the law represents a tangible savings for millions.

The coverage change will entitle every Medicare beneficiary—including those on Medicare Advantage Plans—to be included in the mandate, in which “insurance companies are required to reimburse their enrollees at a rate of up to $12 per test (or the cost of the test, if less),” allowing those most vulnerable to have crucial access to testing.

If You Can’t Wait Until Spring, You Have Options

The cynics among us might say that there has to be a hiccup here, and they would be right…sort of. The new coverage doesn’t begin until spring, which means a gap in reimbursement for those in need of tests now. All is not lost, though, if you need access to tests right away.

O’Brien writes, “For starters, you can order four [test kits] for free through, a government website that launched last month. The site, which is available to all households, requires you to provide only your name and address; no insurance information is needed.”

And Medicare beneficiaries are always able to access testing through the usual means. O’Brien suggests that “beneficiaries can still access free testing outside their home at one of more than 20,000 testing sites where lab-based PCR tests, rapid PCR tests and rapid antigen tests are available.”

“Also,” she adds, “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.”

Medicare Advantage Rules Vary by Company

We all know that reading the fine print is vital, so if you’re enrolled in a Medicare Advantage Plan you might want to check to see if you’re eligible for free at-home tests already, since the plans can vary widely in benefits. 

Those already eligible for free test kits “can also pick them up at Medicare-certified health clinics and community health centers,” O’Brien writes.

While the timeline may not be ideal for everyone, the hope is that at-home testing will soon become accessible and widespread to those who need it most. We will continue to watch this story as it develops, and bring you any updates that we feel are relevant.

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