Which groups are particularly vulnerable to covid-19, even with full vaccination and booster vaccines? elderly. Who will have a hard time getting free home coronavirus testing under the Biden administration’s plan? Yes, senior.
As of January 15th, Private insurers will cover the cost Conduct home rapid covid tests for its members eight times a month for as long as the public health emergency lasts.
Finding a test is hard enough, but Medicare beneficiaries face an even bigger hurdle: government’s The new rules don’t apply to them.
It turns out that the laws governing traditional health insurance don’t cover self-administered diagnostic tests, which is exactly what rapid antigen tests are all about and why they are an important tool in containing the pandemic.
“While Original Medicare cannot pay for home testing at this time, testing remains a critical tool to help mitigate the spread of COVID-19,” said a statement from the Centers for Medicare and Medicaid Services. “As mandated by the 2021 Biden administration, Medicaid and CHIP cover at-home coronavirus testing at no cost to beneficiaries.
Medicare patients can only seek free tests through other means, including through the government’s new website, covidtests.gov, as well as in community centers. Medicare plans do cover lab-performed rapid antigen or PCR tests at no charge to beneficiaries, but there’s one hurdle: Unless someone has a doctor’s order, they can only be tested once a year.
Advocates say more needs to be done.
The U.S. government has changed some health insurance rules during the pandemic, including improving access to telehealth services and nursing home care, said David Lipschutz, the agency’s deputy director and senior policy attorney. Medical Insurance Promotion Center.
“We know that Medicare plans have a lot of flexibility relative to public health emergencies, and have demonstrated their ability to change the rules,” Lipschutz said. “We think they should find the flexibility to offer Covid at-home testing for free.”
Q: Why can’t Medicare plans reimburse beneficiaries for over-the-counter tests or purchase labels at a pharmacy like commercial health plans do?
Federal law regulates services that Medicare pays for.
“It doesn’t usually cover over-the-counter drugs,” said Kathy Schwartz, senior adviser for education and federal policy at the advocacy group Center for Medicare Rights.
recent public health emergency 90 days extension, until mid-April, the government may still decide to expand coverage. Some lawmakers in Congress are urging the government to undertake the tests.
“It is unfair, inefficient, and costing lives to require Medicare recipients — nearly one-fifth of the U.S. population — to pay for home testing out of their own pocket,” Rep. Bill Pascrell ( DN) said. .Y.), he urged the Biden administration to expand Medicare coverage to include them.
This may not be an easy change, as these tests seem to be stuck in a coverage gap. Medicare Part A covers inpatient care, and Part B generally covers provider-based services such as doctor visits and lab tests. Part D covers drugs.
“So there’s a bit of a question of where this type of benefit fits,” Schwartz said.
People on private plans sometimes pay for services up front, which are then reimbursed by their health plan. But that’s not how Medicare works. The plan pays the provider, not the beneficiary. So this is another problem that has to be solved.
Q: So how do Medicare beneficiaries get free home COVID-19 testing?
There are several options. This week, the Biden administration launched a website, covidtests.gov, anyone, including Medicare beneficiaries, Free home covid tests can be ordered. Eventually 1 billion tests will be available. Each residence can initially take four tests.
Four tests are a far cry from the eight monthly tests that people with private insurance can reimburse. But experts say it’s better than nothing, especially if preventing the spread of the new coronavirus requires repeat testing within days.
“Four tests is not a lot of tests,” said Juliette Cubanski, associate director of KFF’s health insurance policy program. “This is one of the most at-risk groups, and there is no opportunity to buy home tests and get reimbursed, which puts the entire population at a disadvantage.”
The Biden administration has also provided community health centers and Medicare Certified Health Clinic.
But Lipschutz said 50 million tests won’t even provide one test for the 62 million Medicare beneficiaries.
About four in 10 Medicare beneficiaries are enrolled in a Medicare Advantage managed care plan. These private plans may offer free at-home testing to members, but this is not required. Registrants should check their plans to see if this is an option.
Q: What other free coronavirus testing options are available to Medicare beneficiaries?
Beneficiaries receive rapid antigen or PCR diagnostic tests at no out-of-pocket cost in traditional health insurance If the test was ordered by a doctor or other healthcare provider and performed by the laboratory.
The federal government has more than 10,000 free pharmacy testing sites across the country that are also accessible to Medicare beneficiaries.
With the recent prolonged public health emergency and unpredictable circumstances, Medicare beneficiaries may also have access to coverage comparable to what private insurers now have for home covid testing.
“It’s all a moving target,” Lipschutz said.
KHN (Kaiser Health News) is a national newsroom that provides in-depth news coverage on health issues.Along with policy analysis and polling, KHN is one of the top three operating programs in the U.S. KFC (Kaiser Family Foundation). KFF is a donating non-profit organization that provides information on health issues to the state.
