Health

Medicare coverage of over-the-counter COVID-19 tests begins

Providers can receive $12 for a home test provided to a Medicare Part B beneficiary starting Monday and during the COVID-19 public health emergency, the Centers for Medicare and Medicaid Services announced.

Beneficiaries are eligible for up to eight free home tests per calendar month. Medicare Advantage members can get eight free tests not covered by their current plan, plus any additional tests covered by their plan as an additional benefit.

The coverage will only apply to beneficiaries enrolled in Medicare Part B, which covers primarily outpatient care. More than 59 million people fall into this category, according to CMS. Beneficiaries with only Medicare or Part A hospital coverage are not eligible for home testing coverage.

Free COVID-19 testing for Medicare recipients will be available at participating pharmacies, including CVS, Costco Pharmacy, Walgreens and Walmart. The program is voluntary, and non-participating pharmacies and providers may continue to sell over-the-counter tests, including to Part B participants.

Other eligible providers, such as physicians, skilled nursing facilities, and independent laboratories, may test and bill Medicare. Medicare does not cover home testing costs if billed by health care providers who perform tests while you are in a hospital.

Participation begins when a provider submits an application to Medicare for testing. A separate participation agreement is not required.

Medicare will pay providers at a flat national rate of $12 per test. If the provider’s typical rate is less than $12 per test, Medicare will reimburse the lower rate.

Claims will be processed in the order in which they are submitted. Providers cannot use registry accounts, a multi-application method, for home testing for COVID. CMS cannot process applications submitted directly by beneficiaries for OTC tests.

CMS recommends that providers only test patients upon request. The agency also said health care providers should keep careful documentation of patient requests for tests. CMS may request documentation, and if it is not provided, the agency may refund the payment and take other administrative actions, in accordance with newsletter.

Beneficiaries cannot be reimbursed for previously purchased tests.

In February, CMS announced it would cover home tests for Medicare recipients following pressure from Capitol Hill and is urging older Americans to correct the fact that people on Medicare had limited access to free COVID-19 home tests. Since January, private insurance companies had to cover eight free home tests for participants. Some Medicare Advantage plans cover COVID-19 home testing, but Medicare generally does not cover over-the-counter health products.

“For the first time in its history, Medicare pays for an over-the-counter test,” said Associate Administrator Dr. Mina Seshamani, director of the Medicare Center at CMS. news release. “[T]his initiative will greatly expand access to testing for Americans most vulnerable to COVID-19 and provide valuable insights into future payment policies that support affordable, comprehensive, people-centered healthcare.”

The agency has used the authority of the Social Security Administration’s demonstration program to allow temporary coverage of home testing for COVID-19, CMS confirmed. This allows the agency to test payment models to see if they improve the effectiveness of Medicare. Medicare Hospice Benefit began as a government-led demonstration program.

Trisha Neumann, senior vice president of KFF and executive director of the Medicare policy program, said using the demonstration project was likely the path of least resistance to rapid coverage of home tests through Medicare.

“In a sense, the secretary of state’s hands are tied without a change in the law, so there are not many alternatives. And this is a pandemic, where people get sick and die, and while the rate of hospitalizations and deaths is decreasing, the fears about the spread are still there,” Neumann said.


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