Most insurers cover costs of at-home COVID tests. That’s not the case with Medicare

Andrew Harnik/AP
·3 min read

Most Americans who buy at-home COVID-19 tests will be reimbursed by their insurers under a recent requirement from President Joe Biden’s administration.

This applies to U.S. citizens with private health coverage – but not for millions of people covered by Medicare, including the many senior citizens and individuals living with disabilities enrolled in the plan, according to the U.S. Department of Health & Human Services.

“Most consumers with private health coverage can go online or to a pharmacy or store, buy a test, and either get it paid for up front by their health plan, or get reimbursed for the cost by submitting a claim to their plan,” HHS said in a Jan. 10 news release about the requirement, which took effect Jan. 15.

“As a Medicare enrollee, I am enraged,” Peggy Matthews-Forney, 70, told CNN. “If anyone needs to have these tests paid for, it’s seniors. The ones at the highest risk are seniors.”

For nearly 64 million people with Medicare, a COVID-19 test will be paid for if it’s ordered by a doctor or another health care worker and conducted through a lab, according to HHS.

The roughly more than 26 million covered under Medicare Advantage are advised by the agency to “see if their plan offers coverage and payment for at-home over-the-counter COVID-19 tests.”

This does not apply to the 1 billion free COVID-19 tests recently offered for free through the U.S. government. The Centers for Medicare & Medicaid Services told CNN that those under Medicare can still get some free COVID-19 tests through the government’s website, which was launched Jan. 18.

Each family household is allowed to place just one order to receive a maximum of four tests, even if there are more than four people in the family, the site says.

Two Democratic U.S. House representatives from New Jersey and California wrote a letter on Jan. 14 to Biden commending how COVID-19 testing has been made “more widely available” — but calling on the administration to take action so Medicare enrollees can have the same free access to at-home tests purchased at retailers.

Rep. Bill Pascrell from New Jersey and Rep. Scott Peters of California wrote “nearly 20% of the population would be made to pay out-of-pocket for COVID-19 test.”

“Americans enrolled in Medicare are among the most susceptible and vulnerable to infection,” they continued, “and among the least able to pay for testing.”

Citizens with private insurance are entitled to up to eight free at-home COVID-19 tests monthly for each individual enrolled in the plan, according to HHS. This means that if eight people live under one roof, a total 64 free COVID-19 tests will be covered if needed.

“There is no limit on the number of tests, including at-home tests, that are covered if ordered or administered by a health care provider following an individualized clinical assessment,” according to HHS, “including for those who may need them due to underlying medical conditions.”

U.S Rep. Henry Cuellar, of Texas, took to Twitter on Jan. 18, saying he signed a letter “urging” HHS “to ensure that Medicare beneficiaries are able to access at-home COVID-19 testing at no cost.”

“This will grant beneficiaries the option to access at-home tests without a health care professional’s order.”

Additionally, pharmacy organization Express Scripts noted how the new private insurance requirement doesn’t apply to those who have Department of Defense health care plans, such as military members.

McClatchy News has reached out to the Centers for Medicare and Medicaid Services for comment.

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