CMS Says Medicare Will Cover At-Home COVID Tests at No Cost

Earlier today, the Centers for Medicare & Medicaid Services (CMS) announced plans to make over-the-counter (OTC) COVID-19 tests available to people with Medicare at no cost by “early spring.”

According to the agency, “[u]nder the new initiative, Medicare beneficiaries will be able to access up to eight over-the-counter COVID-19 tests per month for free. Tests will be available through eligible pharmacies and other participating entities.”

The Medicare Rights Center applauds this development. It appears designed to help correct the imbalance in the administration’s initial OTC testing policy, which applied to private insurers but not Medicare.

As the Kaiser Family Foundation subsequently explained, there were several reasons why Medicare was excluded. For one, the administration relied on authorities in the Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief, and Economic Security (CARES) Act to establish private insurance coverage of the OTC tests. But those laws did not include comparable Medicare flexibilities, and the program’s complex rules caused additional setbacks.

Today’s news signals the administration has found a workaround. CMS notes the significance of the moment—and the challenges behind it—saying, “[t]his is the first time that Medicare has covered an over-the-counter test at no cost to beneficiaries. There are a number of issues that have made it difficult to cover and pay for over-the-counter COVID-19 tests. However, 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.”

While many specifics have not yet been released, in a related FAQ CMS does clarify the tests will be covered under Part B, that the initiative should be operable in the coming weeks, and that more information will be available soon.

“Starting in early spring, people with Medicare will be able to go to eligible pharmacies and other entities that are participating in this initiative to receive over-the-counter COVID-19 tests for free through their Medicare Part B coverage. More information about eligible pharmacies and other entities that are participating in this initiative will be available in the early spring. Once the initiative is up and running, CMS will encourage beneficiaries to ask their local pharmacy or current health care provider whether they are participating in this initiative.”

Today’s release is a promising step in the right direction. Medicare Rights looks forward to learning more about the initiative, as well as about the agency’s plans for implementation, outreach, and education. As we and other advocates recently noted, the Medicare exclusion created an obstacle to care for millions of Americans, many of whom are at increased risk of infection and serious illness from COVID-19. We appreciate the administration’s responsiveness to these concerns. Expanding access to OTC tests at no cost to people with Medicare will help improve individual and public health.  

Until the program is in effect, CMS advises people with Medicare to obtain free tests through the following channels: 

• Request four free OTC tests for home delivery at covidtests.gov.
• Access COVID-19 tests through healthcare providers at over 20,000 free testing sites nationwide. A list of community-based testing sites can be found here.
• Access lab-based PCR tests and antigen tests performed by a laboratory when the test is ordered by a physician, non-physician practitioner, pharmacist, or other authorized health care professional at no cost. In addition to accessing a COVID-19 lab test ordered by a health care professional, people with Medicare can also already access one lab-performed test without an order, also without cost sharing, during the public health emergency.

Read the CMS press release. 

Read the FAQ.