Ask the Medicare Specialist

QUESTION:

Question from Dan: Aaron, I read with interest the news that the government will pay for at home COVID testing and was happy to hear it. But then I also read that Medicare will not pay for these services. Can you offer any clarification and solutions for those of us on Medicare?

ANSWER:

I’m wondering if you might have been confused about the government paying for home tests due to the current administration’s announcement that they were planning on mailing them out for free. As of right now, home tests aren’t covered by Medicare, however, both COVID rapid (Antigen) tests and the P.C.R. tests that take a couple days to get results are for those on Original Medicare and Supplements as well as Advantage Plans. The following was actually published by the Center for Medicare and Medicaid (CMS) the same day Dan emailed me his question: “Health and Human Services (HHS) is providing up to 50 million free, at-home tests to community health centers and Medicare-certified health clinics for distribution at no cost to patients and community members. You can learn more about this program at https://www. cms.gov/www.hrsa.gov/coronavirus/testing-supplies. “HHS also has established more than 10,000 free communitybased pharmacy testing sites around the country. To respond to the Omicron surge, HHS and FEMA are creating surge testing sites in states across the nation. The Biden-Harris Administration is purchasing 500 million at-home, over-the-counter tests to be distributed for free to Americans who want them, with the initial delivery starting in January 2022. There will be a website where all Americans can request at-home tests for home delivery—for free. More information on this federal program is expected soon. “For people covered by original fee-for-service Medicare (this applies to those on Supplements), Medicare pays for COVID-19 diagnostic tests performed by a laboratory, such as P.C.R. and antigen (rapid) tests, with no beneficiary cost sharing when the test is ordered by a physician, non-physician practitioner, pharmacist, or other authorized health care professional. People with Medicare can access one lab performed test without cost sharing per patient per year without an order. At this time Original Medicare cannot pay for at-home tests through this program. Medicare Advantage plans may offer coverage and payment for at-home over-the-counter COVID-19 tests, so consumers covered by Medicare Advantage should check with their plan.” I want to clarify some things from the above CMS statement. Home COVID tests are not covered by Medicare at this time. However, they’re very reasonable to buy without insurance. The Binax test, which seems to be getting good reviews, costs $13 at CVS, according to an ad I saw online. Several others that were given high marks by the New York Times in a recent article cost between $10 and $20. The issue isn’t that home tests aren’t covered or unaffordable; the problem is finding them. About three weeks ago, there wasn’t a pharmacy within 20 miles of Connellsville who had one and I was told when they do come in, they don’t last long. I think the idea of mailing a couple to every person in the country is a great idea and should have been thought of and done months ago. I’m a bit concerned how long it will take for it to happen, however. And if the government is purchasing that many, will there be any available in the meantime? I suggest ordering some online immediately or picking them up if you see any at your pharmacy, even if you aren’t experiencing symptoms. There are no costs for tests for rapid or P.C.R. tests administered at an Urgent Care, Med Express, or Emergency Room for those on Supplements. However, if you went to a drive-up testing site at CVS, Rite Aid, or another pharmacy more than once without a prescription, it would not be covered. I recently did just that and found it very easy to make an appointment online and I had no wait when I pulled up to the CVS drive through. I think this is a much safer and convenient alternative to sitting in an Emergency Room waiting area or your car outside an Urgent Care for hours. If you want to avoid being billed for a drive through test, ask your doctor for a prescription and give it to the person at the window who provides you with the kit or have it sent to the pharmacy prior to your arrival. As far as Advantage Plans, P.C.R. and rapid tests are always covered at an Urgent Care, Med Express, or the Emergency Room without a script at no cost. However, to receive one at a lab where you get blood work done, you would need a physician’s prescription according to what I’ve been told. I’m awaiting word from our Advantage Plan reps to see if a prescription is necessary for a drive through test. They are definitely covered with a prescription. It’s just without that’s the question at this point and how many times you could get one. I’m also waiting to hear if at home tests will be covered by Advantage Plans. As of my deadline, I had not gotten confirmation on that from Western PA’s three largest Advantage Plan companies. I was told it’s currently being discussed and will update everyone as soon as I hear. A reminder that all prior columns can be found on our website as well as the podcast and webcast versions. I will also be doing my bimonthly radio show, Medicare A to Z, this coming Monday, January 17th from 1:15 to 3pm on WMBS Uniontown, 590 AM and 101.1 FM. You can also listen via their website, wmbs590.com. If you have any questions regarding this topic, one for a future column, or those of a more personal nature, please feel free to contact me via email at aaron@getyourbestplan.com. To make an appointment for a no cost consultation, call one of our offices. As always, thanks for reading. Stay safe.