CMS Updates Medicare Part B OTC COVID-19 Testing Coverage

In a historic move, CMS has announced that Medicare Part B beneficiaries can receive full coverage for up to eight over-the-counter coronavirus tests in a calendar month during the coronavirus public health emergency.

The agency noted that this is the first time that the public payer program has fully covered an over-the-counter self-administered test.

The coverage is effective as of April 4, 2022 and will continue through the end of the public health emergency. According to an accompanying CMS fact sheet, Medicare Part B beneficiaries can receive as many eight fully-covered over-the-counter tests through April 30. Thereafter, beneficiaries can receive an additional eight tests each month.

Beneficiaries with only Medicare Part A cannot receive coverage for over-the-counter coronavirus tests through this initiative, the CMS fact sheet qualified.

“Testing remains a critical tool in mitigating the spread of COVID-19, and we are committed to making sure people with Medicare have the tools they need to stay safe and healthy,” CMS Administrator Chiquita Brooks-LaSure noted. “By launching this initiative, the Biden-Harris Administration continues to demonstrate that we are doing everything possible to make over-the-counter COVID-19 testing free and accessible for millions more Americans.”

Prior to this most recent announcement, the public payer program covered four tests at a time and up to eight tests per month. Now, beneficiaries can receive those eight tests per month which are available to all Americans and an additional eight tests that are fully covered through Medicare.

“With today’s announcement, we are expanding access to free over-the-counter COVID-19 testing for people with Medicare Part B, including those enrolled in a Medicare Advantage plan,” said Secretary of the Department of Health and Human Services (HHS) Xavier Becerra.

“People with Medicare Part B will now have access to up to eight FDA-approved, authorized or cleared over-the-counter COVID-19 tests per month at no cost. This is all part of our overall strategy to ramp -up access to easy-to-use, at-home tests free of charge.”

The press release noted 14 national pharmacy chain participants, including Food Lion, CVS, and Walmart, but a Medicare webpage noted that there are other pharmacies participating.

“Since we took office, we have more than tripled the number of sites where people can get COVID-19 tests for free, and we’re also delivering close to 250 million at-home, rapid tests to send for free to Americans who need them," said HHS Secretary Xavier Becerra. "Under the Biden-Harris Administration’s leadership, we required state Medicaid programs, insurers and group health plans to make tests free for millions of Americans. With today’s step, we are further expanding health insurance coverage of free over-the-counter tests to Medicare beneficiaries, including our nation’s elderly and people with disabilities.”

CMS foreshadowed this announcement in February 2022. At the time, however, the agency did not provide details on which pharmacies would be participating or when precisely the coverage would go into effect.

Shortly after previewing the announcement in early February, CMS released guidance regarding how to provide access to over-the-counter coronavirus tests for both in-person and direct-to-consumer shipping purchases.

Before establishing Medicare coverage policies for coronavirus testing, CMS issued requirements around commercial payer coverage, which included Medicare Advantage plans.

At the time, payer organizations including AHIP, ACHP, and the Blue Cross Blue Shield Association applauded the administration’s drive to ensure affordability and access to coronavirus testing but expressed concerns about the timeline, lack of a national testing strategy, and limited supply of coronavirus tests.