COVID Tests to be Covered by the Medicare Program

This article was written in 2022. The facts and figures are current as of then. With the lifting of many COVID-19 restrictions, we will no longer be updating the article. While much of it remains true, we encourage our readers to check with CMS and the Medicare program to get the most updated information.

As part of the government’s efforts to prevent further spread of COVID-19, the Centers for Medicare & Medicaid Services (CMS) announced last week that the Medicare program will be covering COVID tests for beneficiaries. This is the first time that COVID tests will be covered in this manner, making it easier than ever to find out if you have the virus. Previously, Medicare Advantage plans could cover over-the-counter COVID tests as a supplemental benefit, but Original Medicare did not. This will change once this new policy goes into effect.

All facts and figures can be found in the official CMS press release and the corresponding FAQ unless a specific link is provided.

The Medicare Program’s Coverage of COVID Tests

This new policy by CMS will allow Medicare Part B to cover the full cost of over-the-counter COVID tests. By paying the pharmacies directly, beneficiaries won’t need to pay for the tests and then request reimbursement. Instead, if you’re enrolled in Medicare, the test will come at no cost to you at the point of sale, simplifying the entire process. As it stands, the current plan is to cover up to eight COVID tests per month.

If you’re enrolled in Medicare, the test will come at no cost to you at the point of sale.

Although no specific start date has been mentioned, this program is expected to begin in early spring. Eligible pharmacies and other participating locations will be accepting this program, and CMS will encourage beneficiaries to check with their local pharmacies and health care providers to see if they participate. As more details are released, we’ll be sure to keep you updated!

What Can We Do Until Then?

Unfortunately, the pandemic can’t be put on pause until Medicare insurance covers the tests. So, what can you do in the meantime? First, you can go to one of the over 20,000 testing sites nationwide for a low-to-no cost COVID test. Locations can be found through the Department of Health & Human Services’ (HHS) Community-Based Testing Sites finder or by calling 1-800-MEDICARE for more details.

Second, by working with your health care provider, you are able to receive lab-based PCR and lab-performed antigen tests when ordered by your physician. These tests are covered through the Medicare program at no cost to you. Medicare insurance beneficiaries are also eligible for one lab-performed test without a provider’s order during the ongoing public health emergency. This also is available to you without cost sharing.

Between these three options, you should be able to get any tests you need until the CMS program is in place.

A final, convenient option is to receive free, at-home COVID tests delivered directly to you with covidtests.gov. This option is available to any citizen, with or without Medicare, and allows households to have up to four at-home tests delivered to them. Between these three options, you should be able to get any tests you need until the CMS program is in place.

Have There Been Other Mitigation Programs Recently?

This isn’t the only program that has been introduced recently to try and curb the spread of COVID. A federal program that started January 15, 2022, requires insurance companies and health plans to cover eight free at-home tests, per individual, per month. While Medicare insurance enrollees are not eligible for this initiative, it provides family members who are not currently enrolled in the Medicare program access to free tests.

The Biden administration has released 400 million N95 masks from the federal stockpile to pharmacies to be given out for free with each person able to take up to three.

Along with making testing more available, the Biden administration has released 400 million N95 masks from the federal stockpile to pharmacies in the federal pharmacy program. This includes many major grocery stores and retail pharmacy chains. These masks will be given out for free with each person able to take up to three.

● ● ●

With increased testing access, free masks, and free vaccines and boosters, the tools we need to navigate through this current health crisis are, thankfully, available. As soon as we learn more details about this program and when it will start, we’ll provide updates. So, keep your eyes on the Shop & Enroll blog!