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The COVID-19 pandemic has had a major impact on our lives. The infection can be serious at any age but people 65 and older are at higher risk for complications. This puts the Medicare population at a disadvantage.
Getting tested for COVID-19 when you have symptoms or when you have had exposure to the virus is essential. You need to know when you have been infected so that you can seek appropriate treatment. Not only that, it lets you know when to isolate so you can prevent the spread to others.
But access to testing has long been an issue, both in terms of availability and costs. To address the cost aspect, the federal government began requiring most health plans cover the cost of at-home COVID tests in early 2022 – but that rule did not initially apply to Medicare. Starting April 4, however, enrollees can get free in-home COVID tests from Medicare like other health plans.
Here’s what you need to know about access to COVID tests:
How can I get free at-home COVID-19 tests mailed to me?
All Americans – regardless of their insurance coverage – were eligible for free at-home COVID-19 screening tests from the federal government. Each household qualified for two free shipments of four tests each. The quantity limit may not have been adequate for larger families, but some free testing is better than none.
The tests were shipped through the U.S. Postal Service. The free at-home COVID-19 test program ran from January 19, 2022 to September 2, 2022. Although the federal government is not providing free tests at this time, it has taken steps to ensure that people are able to get free tests through their health insurance – Medicare included.
Will Medicare pay for at-home COVID tests I can get at a local pharmacy?
Starting on January 15, 2022, the Biden administration required that most health plans cover the cost of eight at-home COVID tests per month per person. (This is separate from the four free tests described above, that households can order through the mail.)
But this rule did not initially apply to Medicare. That’s because Medicare Part B had not previously covered over-the-counter tests, and was only set up to cover testing ordered by and performed by a healthcare provider. Medicare Advantage plans were allowed to voluntarily cover the cost of at-home COVID tests, but most of the major Medicare Advantage insurers had chosen not to do so.
Fortunately for Medicare beneficiaries, the Biden administration announced on February 3 that Medicare would level the playing the field by covering the cost of at-home COVID tests by early spring 2022. As of April 4, beneficiaries with Medicare Part B – including those with Original Medicare and those with Medicare Advantage – are now able to obtain up to eight tests per month at participating clinics, pharmacies, and stores. Be sure to ask if your healthcare provider is taking part in this program to make sure any tests you get will be covered.
Of note, some Medicare Advantage plans cover over-the-counter tests as a supplemental benefit. In those cases, the eight tests covered by this new Medicare initiative are in addition to any coverage you already get from your plan.
Are there other ways to get free at-home COVID tests?
The Biden administration has provided community health centers and Medicare-certified health clinics with 50 million free at-home tests to distribute to people in need. This will especially help people who are underinsured or who do not have insurance at all.
Unfortunately, when you consider that there are more than 61 million people on Medicare, this number of tests may not be enough to help a large portion of older Americans get screened as often as they need to. But the fact that Medicare is now covering the cost of up to eight at-home COVID tests per beneficiary per month will help to ensure better access to COVID testing.
Medicare beneficiaries who are also enrolled in Medicaid may have more options. The American Rescue Plan requires that Medicaid cover at-home tests for free, as long as those tests have been approved by the Food and Drug Administration.
Is COVID testing covered if I go to a lab?
Medicare continues to pay for COVID tests that are ordered by healthcare providers and that are performed in a lab. At this time, people on Original Medicare can go to a lab to get a COVID test performed without a doctor’s order but it will only be covered this way once per year.
Your best bet is to get a doctor’s order if you want to get tested for free.
Tanya Feke M.D. is a licensed, board-certified family physician. As a practicing primary care physician and an urgent care physician for nearly ten years, she saw first-hand how Medicare impacted her patients. In recent years, her career path has shifted to consultant work with a focus on utilization review and medical necessity compliance. She currently works as a physician advisor at R1 RCM, Inc., where she performs case reviews for hospitals nationwide.
Dr. Feke is an expert in the field, having Medicare experience on the frontlines with both patients and hospital systems. To educate the public about ongoing issues with the program, she authoredMedicare Essentials: A Physician Insider Reveals the Fine Print. She has been frequently referenced as a Medicare expert in the media and is a contributor to multiple online publications. As founder of Diagnosis Life, LLC, she also posts regular content about health and wellness to her site at diagnosislife.com.
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