Medicare Will Cover OTC Coronavirus Tests At The Counter

CMS has announced that Medicare will cover over-the-counter coronavirus tests.

Medicare beneficiaries will be able to access free over-the-counter coronavirus tests through covidtests.gov. The tests will be delivered to their homes.

Beneficiaries will receive coverage for their tests at the counter under Medicare Part B, not through later reimbursement.

“This is the first time that Medicare has covered an over-the-counter test at no cost to beneficiaries,” CMS explained in the press release. “There are a number of issues that have made it difficult to cover and pay for over-the-counter COVID-19 tests. However, given the importance of expanding access to testing, CMS has identified a pathway that will expand access to free over-the-counter testing for Medicare beneficiaries.”

The agency has not yet released a list of pharmacies and providers participating in this endeavor but plans to do so in the spring of 2022, CMS shared in a fact sheet.

Medicare Advantage beneficiaries might already have access to free over-the-counter coronavirus testing. This coverage would be provided as a supplemental benefit. However, not all Medicare Advantage plans are participating.

The newly-announced, additional coverage will not go into effect until the spring of 2022, CMS explained.

In the interim period between this announcement and the launch date, the agency placed a limit on the number of tests that beneficiaries can receive that was similar to the maximum it required from commercial insurer coverage of at-home coronavirus tests earlier in the year. Beneficiaries can receive coverage for four tests at a time and a maximum of eight tests per month.

The agency also provided a list of community-based testing sites through which beneficiaries can access over-the-counter tests for free.

The announcement is in response to the Biden administration’s plan to expand access to at-home coronavirus testing, a plan that the White House announced back in December 2021.

Since then, CMS has directed commercial health plans to cover at-home coronavirus testing and incentivized plans to do so at the counter. Private payers and Medicaid programs have taken a variety of approaches to fulfilling that directive.

However, ultimately, all efforts are hampered by a lack of coronavirus tests. In January 2022, almost 30 percent of consumers reported challenges in accessing coronavirus tests over the past six months, according to an eHealth survey. Nearly half of the survey participants who had contracted COVID-19 reported that they had difficulty accessing a coronavirus test.