Demand for home COVID-19 tests soared in recent months as the emergence of the Omicron variant strained America’s testing capabilities. The Biden administration responded by making four free home COVID tests from the government available to every U.S. household and by announcing that private health insurers must reimburse customers for home COVID tests. But one large and particularly vulnerable group found itself left out of this push to make home tests more accessible. Though people 65 and older make up about three-quarters of the nation’s COVID death toll, the policy on home-test reimbursement does not apply to people on Medicare, the federal insurance system for elderly and disabled Americans.
On Thursday, following widespread criticism from members of Congress and advocates for the elderly, the Biden administration announced that free home tests will be available to the 64 million people on Medicare — but not until “early spring.” Here’s what we know about the program and how Medicare beneficiaries can get affordable COVID tests while they’re waiting for it to start.
When can Medicare beneficiaries start picking up free home COVID tests?
A news alert issued by the Centers for Medicare and Medicaid Services on Thursday announced, “As part of the Biden-Harris Administration’s ongoing efforts to expand Americans’ access to free testing, 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.”
The official start of spring is March 20. The Biden administration’s recent COVID-prevention initiatives have gone into effect on or before the expected launch date (covidtests.gov starting accepting orders a day early). CMS is currently “working around the clock to implement this initiative,” according to a list of frequently asked questions attached to the February 3 announcement.
Will people have to buy the tests first and file for reimbursement?
No. Most private insurers are requiring customers to pay for the tests out of pocket then fill out a form requesting reimbursement. But obtaining free tests should be far simpler for Medicare beneficiaries. CMS’s fact sheet says the initiative “will enable payment directly to eligible pharmacies and other entities that are participating in this initiative to allow Medicare beneficiaries to pick up tests at no cost at the point of sale and without needing to be reimbursed.” In other words, you should be able to walk into a participating pharmacy, show that you’re on Medicare, and pick up free tests without pulling out cash or a credit card.
How many free home COVID tests will be available?
Each Medicare beneficiary can claim up to eight free over-the-counter home tests per month. This is in addition to the four free COVID tests available to every U.S. household at covidtests.gov.
Eight tests per month for Medicare beneficiaries matches what private insurers must cover for their customers. There is no limit on lab-conducted COVID tests ordered by a doctor.
Where will the free home tests be available?
The tests will be available to Medicare beneficiaries “through eligible pharmacies and other participating entities,” according to the CMS announcement. Meena Seshamani, the director of CMS’s Center for Medicare, told the Washington Post that the program will include pharmacies that already participate in Medicare plus other retailers that want to be involved.
What kind of home COVID test will be covered?
The CMS announcement uses the general term “over-the-counter COVID-19 tests.” Most home COVID tests authorized by the FDA are antigen tests, but there are a few (pricier) home molecular tests on the market. (Here’s an explainer on the various kinds of home COVID tests.) CMS has yet to say anything about what specific types or brands of test will be fully covered by Medicare.
Who is eligible?
“All Medicare beneficiaries with Part B will be eligible to get eight free over-the-counter COVID-19 tests per month through our new initiative,” according to CMS.
Medicare Advantage Plans may already cover home COVID tests. If you’re enrolled in a Medicare Advantage Plan, CMS recommends checking with the plan to see if it already covers the tests.
How can Medicare beneficiaries get free COVID tests right now?
CMS notes that people on Medicare already have a number of options if they want free or low-cost COVID tests:
- They can go to covidtests.gov or call 1-800-232-0233 to request four free home tests. The tests will be delivered by the U.S. Postal Service, and there is no shipping fee.
- They can access low- to no-cost COVID testing by a health-care provider at more than 20,000 test sites nationwide. A list of these test sites is available here.
- They can get an unlimited number of free lab-based PCR or rapid antigen tests if the tests are ordered by a doctor, nonphysician practitioner, pharmacist, or other authorized health-care professional.
- They can access one lab-performed test without an order from a medical professional, with no cost sharing, for the duration of the public-health emergency.
Medicare beneficiaries can call 1-800-633-4227 (1-800-MEDICARE) if they have further questions about where to find a test.
Why did it take so long for Medicare to provide free home COVID tests?
The key holdup, as the Washington Post reported, is laws governing the traditional version of Medicare do not allow coverage for over-the-counter health products. In fact, CMS noted that this will be the first time Medicare has covered an over-the-counter test at no cost to beneficiaries.
Seshamani told the Post that CMS has now identified a workaround:
She said in an interview that the agency figured out it could devise a method to pay pharmacies and other places for the tests. To do so, it is relying on permission Congress has long given the Medicare program to experiment with payment and benefits rules if an innovation seems likely to improve access to care or lower costs.
So far, CMS has not explained exactly how this will work. But Medicare beneficiaries are now one step closer to having better access to an important tool for controlling the pandemic.
