Medicare's 64 million beneficiaries can now get free over-the-counter COVID-19 tests from pharmacies and other stores that participate in the program.
Medicare enrollees in Part B can receive up to eight at-home tests per month, the Centers for Medicare and Medicaid Services (CMS) announced on Feb. 3. Medicare will pay eligible pharmacies and other participating locations directly, so beneficiaries will not have to pay anything up front for the tests.
This new program applies both to people with original Medicare and to those who are enrolled in a Medicare Advantage (MA) plan. MA plans had already been authorized to offer the over-the-counter COVID-19 tests at no charge as a supplemental benefit. Medicare will cover only over-the-counter tests approved or authorized by the U.S. Food and Drug Administration (FDA).
Medicare beneficiaries originally left out
When the White House first announced in January its plan to require insurers to pay for at-home tests, it did not include coverage for Medicare beneficiaries. AARP and other advocates pushed back strongly, saying that America's older adults, who are most vulnerable to the coronavirus, need to have these tests available to them at no charge. This will be the first time that Medicare will cover any over-the-counter products at no cost to beneficiaries.
"We know that people 65 and older are at much greater risk of serious illness and death from this disease — they need equal access to tools that can help keep them safe," said Nancy LeaMond, AARP executive vice president and chief advocacy and engagement officer. "The cost of paying for tests and the time needed to find free testing options are barriers that could discourage Medicare beneficiaries from getting tested, leading to greater social isolation and continued spread of the virus.
“It is clear that regular testing is a crucial part of managing the spread of COVID-19," LeaMond added. "That’s why AARP has been calling for coverage of at-home tests under Medicare equal to that of private health insurance. We are pleased that CMS listened to our concerns and found a path forward to cover over-the-counter tests for seniors."
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Rapid tests, also known as antigen tests, provide results in as little as 15 minutes, compared to the several days it can take to get results from PCR — polymerase chain reaction — tests, which must be processed by a lab. PCR tests, however, are generally considered more accurate than rapid antigen tests. The rapid tests are typically sold in boxes of two.
Medicare beneficiaries can still request four free over-the-counter tests delivered to their homes through the federal government website covidtests.gov. These tests are available to all Americans. If a beneficiary's provider prescribes a PCR test, they are available at no charge at more than 20,000 free testing sites. In addition, people with Medicare can still access one PCR test for free, without a prescription.
Editor’s note: This story was updated with new information.
Dena Bunis covers Medicare, health care, health policy and Congress. She also writes the “Medicare Made Easy” column for the AARP Bulletin. An award-winning journalist, Bunis spent decades working for metropolitan daily newspapers, including as Washington bureau chief for the Orange County Register and as a health policy and workplace writer for Newsday.