What group is especially susceptible to the ravages of covid-19 even when fully vaccinated and boosted? Seniors. And who'll have an especially hard time getting free at-home covid tests underneath the Biden administration's plan? Yes, seniors.
As of Jan. 15, private insurers will cover the price of eight at-home rapid covid tests every month for their members – for as long as the public health emergency lasts.
Finding the tests is going to be with enough contentration, but Medicare beneficiaries face a level bigger hurdle: The administration's new rule doesn't affect them.
It works out the laws governing traditional Medicare don't offer coverage of self-administered tests, which is precisely what the rapid antigen tests are and why they are an essential tool for containing the pandemic.
“While at the moment original Medicare cannot purchase at-home tests, testing remains a vital tool to assist mitigate the spread of covid,” a statement in the federal Centers for Medicare & Medicaid Services said. Medicaid and CHIP cover at-home covid tests, without any cost to beneficiaries, with different 2022 Biden administration mandate.
Medicare people are left to find free tests other ways, including with the administration's new website, covidtests.gov, and also at community centers. The Medicare program does cover rapid antigen or PCR testing done by a lab without charging beneficiaries, but there's a hitch: It's limited to one test each year unless someone includes a doctor's order.
More must be done, advocates say.
The administration is different some Medicare rules throughout the pandemic, including improving access to telehealth services and nursing home care, said David Lipschutz, associate director and senior policy attorney in the center for Medicare Advocacy.
“We realize that the Medicare program has significant flexibility relative to the public health emergency, and contains demonstrated it has the ability to alter the rules,” Lipschutz said. “We think they ought to find the flexibility to offer the covid at-home tests free of charge.”
Q: Why can't the Medicare program reimburse beneficiaries for the over-the-counter tests or pick up the tab at the pharmacy as commercial health plans will do?
The services the Medicare program pays for are explained in federal law.
“It generally excludes over-the-counter things,” said Casey Schwarz, senior counsel for education and federal policy in the Medicare Rights Center, an advocacy group.
The public health emergency was recently extended 90 days, through mid-April, and the administration could yet decide to expand coverage. Some lawmakers in Congress are reportedly urging the administration to cover the tests.
It might not be a simple change, because these tests seem to fall into coverage gaps. Medicare Medicare part a covers hospitalization, and Medicare part b generally covers provider-based services like doctor visits and diagnostic tests. Part D covers drugs.
“So there is a bit of an issue of where this kind of benefit would fit,” Schwarz said.
People in private plans sometimes pay upfront for services after which are reimbursed by their own health plan. But that is not how Medicare works. This program pays providers, not beneficiaries. So that's another wrinkle that would have to be ironed out.
Q: So how can a Medicare beneficiary get free at-home covid tests?
There are a couple of options. Now, the Biden administration launched an internet site, covidtests.gov, where anyone, including Medicare beneficiaries, can order free at-home covid tests. One billion tests eventually is going to be available. Each residence initially can receive four tests.
Four tests is really a long way away from the eight monthly tests that individuals with private insurance can be reimbursed for. But it is an improvement on nothing, experts say, especially when preventing multiplication of covid requires repeated testing over a period of days.
“Four tests is not a lot of tests,” said Juliette Cubanski, deputy director of the program on Medicare policy at KFF. “This is among the most at-risk populations, and also to not have the chance to buy at-home tests and get reimbursed puts this whole population on their own back foot.”
The Biden administration is also providing as much as 50 million additional free at-home tests to community health centers and Medicare-certified health clinics.
But 50 million tests won't even provide one test apiece towards the 62 million Medicare beneficiaries, Lipschutz said.
About 4 in 10 Medicare beneficiaries have been in Medicare Advantage managed-care plans. These private plans offer free at-home tests to members, but it's not required. Enrollees should check with their plans to decide if that's an option.
Q: What other free covid testing choices are open to Medicare beneficiaries?
In traditional Medicare, beneficiaries could possibly get rapid antigen or PCR tests without paying anything out-of-pocket if the test is ordered with a doctor or any other doctor and performed by a lab.
The federal government provides a lot more than 10,000 free pharmacy testing sites across the nation that Medicare beneficiaries can visit as well.
With the recent extension of the public health emergency, everything is fluid, and Medicare beneficiaries may yet get coverage for at-home covid tests that's similar to what privately insured people are in possession of.
“This is all a moving target,” Lipschutz said.
Michelle Andrews:
andrews.khn@gmail.com,
@mandrews110
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