Over-the-Counter COVID-19 Tests and Medicare
As per the government’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. Under the new initiative, Medicare beneficiaries will be able to access up to eight over-the-counter COVID-19 tests per month for free. Tests will be available through eligible pharmacies and other participating entities.
This policy will apply to COVID-19 over-the-counter tests approved or authorized by the U.S. Food and Drug Administration (FDA). Right now, Medicare Advantage Plans may cover and pay for over-the-counter COVID-19 tests as a supplemental benefit in addition to covering Medicare Part A and Part B benefits.
Once the initiative is up and running, beneficiaries need to ask their local pharmacy or current healthcare provider whether they are participating in this initiative.
This is the first time that Medicare has covered an over-the-counter test at no cost to beneficiaries. 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.
This new initiative will enable payment from Medicare directly to participating pharmacies and other participating entities to allow Medicare beneficiaries to pick up tests at no cost. CMS anticipates that this option will be available to people with Medicare in the early spring.
This new 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.
Medicare beneficiaries can:
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- Request four free over-the-counter tests for home delivery at covidtests.gov.
- Access COVID-19 tests through healthcare providers at over 20,000 free testing sites nationwide. A list of community-based testing sites can be found here.
- Access lab-based PCR tests and antigen tests performed by a laboratory when the test is ordered by a physician, non-physician practitioner, pharmacist, or other authorized health care professional at no cost. In addition to accessing a COVID-19 lab test ordered by a health care professional, people with Medicare can also already access one lab-performed test without an order, also without cost-sharing, during a public health emergency.
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- Medicare Advantage plans may offer coverage and payment for over-the-counter COVID-19 tests as a supplemental benefit in addition to covering Medicare Part A and Part B benefits, so Medicare beneficiaries covered by Medicare Advantage should check with their plan to see if it includes such a benefit.
- All Medicare beneficiaries with Part B are eligible for the new benefit, whether enrolled in a Medicare Advantage plan or not.
You can also refer to the FAQs regarding COVID-19 Over-the-counter (OTC) Tests & Medicare. Medical Billers and Coders (MBC) is a leading medical billing company providing complete revenue cycle management services. For provider education, we share the latest billing news and updated billing guidelines in the form of a blog.
For the latest medical billing and coding resources, visit our blogs page. If you need any help in medical billing and coding for your practice, contact us at info@medicalbillersandcoders.com/ 888-357-3226
FAQs
1. What is the new Medicare initiative for COVID-19 tests?
Starting in early spring, Medicare beneficiaries will be able to get up to eight free over-the-counter COVID-19 tests per month from eligible pharmacies and participating entities.
2. Who is eligible for the free COVID-19 tests under Medicare?
All Medicare beneficiaries, including those with Original Medicare or Medicare Advantage, are eligible for free over-the-counter COVID-19 tests as long as the tests are FDA-approved.
3. How can beneficiaries get the free COVID-19 tests?
Beneficiaries can pick up the tests at no cost from participating pharmacies or request four tests for home delivery via covidtests.gov.
4. Can Medicare Advantage plans cover over-the-counter COVID-19 tests?
Yes, Medicare Advantage plans may cover over-the-counter COVID-19 tests as a supplemental benefit, in addition to their standard coverage of Medicare Part A and Part B benefits.
5. How do beneficiaries access lab-based COVID-19 tests?
Medicare beneficiaries can access lab-based tests ordered by a healthcare professional, such as a doctor or pharmacist, at no cost, including one test during a public health emergency without an order.
