Medicare Details New Coverage of At-Home COVID-19 Tests 

On Monday, the Centers for Medicare and Medicaid Services (CMS) announced that for the duration of the COVID-19 public health emergency period, Medicare will cover up to eight over-the-counter (OTC) COVID-19 tests per enrollee, per month, at no cost.

People with Part B, whether in Original Medicare or a Medicare Advantage (MA) plan, can obtain the free tests from any participating pharmacy or health care provider; they are not required to be a current patient or customer and do not need a prescription. Beneficiaries may need to show their red, white, and blue Medicare card—even if they have another card for an MA or Part D plan—but will not be responsible for any cost sharing.

CMS notes the significance of the new policy, saying, “This is the first time that Medicare has covered an over-the-counter self-administered test at no cost to beneficiaries. This new initiative enables payment from Medicare directly to participating eligible pharmacies and other health care providers to allow Medicare beneficiaries to receive tests at no cost.”

A partial list of participating entities can be found here. To date, it includes national pharmacy chains such as Costco, CVS, Food Lion, Giant Food, Kroger, Rite Aid, Walgreens, and Walmart. As this list is likely to grow, CMS advises people with Medicare to check with their pharmacy or health care provider to find out whether they are participating. If so, they can provide the tests and will bill Medicare on the beneficiary’s behalf.

Importantly, these tests are distinct from and in addition to those already available, including for free through covidtests.gov, and as ordered by health care providers at community-based testing sites and labs. They are also separate from any that may be offered through an enrollee’s MA plan. As CMS explains, “If you are in a Medicare Advantage plan, the tests covered under this initiative will be covered outside of your existing plan’s coverage, and in addition to any over-the-counter tests that may be covered under the plan as a supplemental benefit.”

The Medicare Rights Center applauds the new initiative. It appropriately corrects the imbalance in the administration’s initial OTC testing policy, which applied to private insurers but not Medicare. The administration previously announced it had found a workaround, and the details released this week provide needed clarity and coverage.

Read the CMS Press Release, Biden-Harris Administration Announces a New Way for Medicare Beneficiaries to Get Free Over-the-Counter COVID-19 Tests.

Read the CMS Fact Sheet, Medicare Covers Over-the-Counter COVID-19 Tests and FAQ, Medicare Coverage of Over-the-Counter COVID-19 Tests: Frequently Asked Questions.

People with Medicare can get additional information by contacting 1-800-MEDICARE and going to: https://www.medicare.gov/medicare-coronavirus.