Medicare Announces Coverage of Free Over-the-Counter COVID Tests

As discussed in last week’s CMA Alert, on January 10, 2022 the Biden Administration announced that certain private insurance companies and group health plans must cover the cost of over-the-counter, at-home COVID-19 tests. While the administration is also taking additional steps to expand access to free at-home tests, Medicare had been excluded from this requirement.

Today, February 3, 2022, the Centers for Medicare & Medicaid Services (CMS) announced that Medicare will cover free over-the-counter COVID-19 tests. We applaud CMS for overcoming technical hurdles and finding “a pathway that will expand access to free over-the-counter testing for Medicare beneficiaries.”

According to the announcement, “people in either Original Medicare or Medicare Advantage will be able to get over-the-counter COVID-19 tests at no cost starting in early spring. Under 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. This policy will apply to COVID-19 over-the-counter tests approved or authorized by the U.S. Food and Drug Administration (FDA).”

The announcement goes on to say that until these tests are available in early Spring, “people with Medicare can access free tests through a number of channels established by the Biden-Harris Administration. Medicare beneficiaries can:

• Request four free over-the-counter 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.

In addition:

• Medicare Advantage plans may offer coverage and payment for over-the-counter COVID-19 tests as a supplemental benefit in addition to covering Medicare Part A and Part B benefits, so Medicare beneficiaries covered by Medicare Advantage should check with their plan to see if it includes such a benefit.  

All Medicare beneficiaries with Part B are eligible for the new benefit, whether enrolled in a Medicare Advantage plan or not.

For more information, please see these Frequently Asked Questions: https://www.cms.gov/files/document/covid-19-over-counter-otc-tests-medicare-frequently-asked-questions.pdf (PDF)