Saturday, May 21, 2022

Medicare to Cover Free Over-the-Counter COVID Tests

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Medicare to Cover Free Over-the-Counter COVID Tests

Currently, Medicare Advantage Plans may cover and pay for COVID-19 tests purchased over-the-counter as a supplemental benefit and Medicare Part A and Part B benefits. If you have a Medicare Advantage Plan, check if these tests are currently covered and paid for by your plan.

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This new program will provide eight free over-the-counter COVID-19 tests every month to all Medicare Part B participants, regardless of whether they are enrolled in a Medicare Advantage plan.

  • Each calendar month, Medicare pays up to 8 over-the-counter COVID-19 tests at no cost to you.
  • Until the COVID-19 public health emergency is over, this coverage will continue.
  • These tests will be covered if you have Medicare Part B (Medical Insurance). (If you have Medicare Part A (Hospital Insurance) coverage, you will not be covered for over-the-counter COVID-19 tests.) However, you may still be able to acquire free trials through other programs or insurance coverage.)
  • If you have a Medicare Advantage Plan, you will not receive this benefit through your plan; instead, you will receive it as if you were not enrolled.
  • To acquire your free COVID-19 tests over-the-counter, you may need to show your red, white, and blue Medicare card (even if you have another card for a Medicare Advantage Plan or Medicare Part D plan).

When will I be able to get a free COVID-19 test under my Medicare coverage?

Medicare recipients can get free tests through various routes set up by the Biden-Harris administration. However, until free tests are accessible at local pharmacies and medical professionals, Medicare members can take advantage of free trials through a variety of methods.

COVID-19 tests are available through healthcare practitioners at over 20,000 accessible testing locations around the country.

When a physician requests the test, a non-physician practitioner, pharmacist, or other approved health care provider. You can get free lab-based COVID-19 PCR testing and antigen tests.

Medicare beneficiaries can also have one free lab-performed test without an order during a public health emergency.

Over-the-counter COVID-19 tests may be covered and paid for as a supplemental benefit by Medicare Advantage plans covering Medicare Part A and Part B services. Thus Medicare Advantage beneficiaries should check with their plan to determine if it provides such a benefit.

When will this endeavor get underway?

It began on April 4, 2022, and will expire until the lifted COVID-19 public health emergency (PHE). People with Medicare Part B can get up to eight free over-the-counter tests in April if they get them by April 30, and another set of eight free over-the-counter tests in each consecutive calendar month until the COVID-19 PHE expires.

CMS will advise beneficiaries to ask their local pharmacy or existing health care provider if they are participating in this program once the industry is up and running.

Is it necessary for me to purchase the tests first and then get reimbursed?

No. This new program will allow Medicare beneficiaries to pick up tests at no cost at the point of sale and without being reimbursed by paying directly to participating pharmacies and other entities. CMS is working around the clock to put this program in place, and we expect it to be available to Medicare beneficiaries in the early spring.

How will I be able to obtain testing as a result of this initiative?

COVID-19 tests are available over-the-counter at any pharmacy or health care practitioner that participates in this project. First, see if your pharmacy or healthcare provider has any issues. If that’s the case, they’ll be able to perform your tests and charge Medicare on your behalf. Even if you have a Medicare Advantage Plan or a Medicare Part D plan, you should bring your red, white, and blue Medicare card to have your free testing, but the pharmacy may be able to get the information it needs to bill Medicare without it.

Is it necessary for me to switch pharmacies to receive a free test?

No. Even if you aren’t a current customer or patient, you can acquire your free COVID-19 tests from any eligible pharmacy or health care provider who voluntarily participates in this effort. In addition, any medicines you have in place will not be affected by your tests.

Is it possible to get a refund for any exams I purchased before April 4, 2022?

No. After the project begins on April 4, 2022, Medicare coverage and reimbursement will be provided for up to eight over-the-counter COVID-19 tests each calendar month received from a participating pharmacy or health care practitioner. COVID-19 tests purchased over-the-counter before April 4, 2022, will not be covered by Medicare.

As part of this initiative, will I have to pay anything to acquire COVID-19 testing over the counter?

You will not be charged if you visit an approved pharmacy or health care practitioner who participates in this program. However, Medicare will not pay for additional over-the-counter testing if you have more than the eight authorized COVID-19 tests in a calendar month. As a result, unless you have other health coverage, you may be responsible for the expense of other tests that calendar month. If you have supplemental coverage, check if any extra tests obtained exceeding the Medicare quantity limit are covered. This means you may be asked to pay for them by the pharmacist or your health care practitioner. It’s worth noting that exams are often packaged in boxes with more than one test, so eight tests can come in fewer than eight boxes.

Is there a time limit on how long I can acquire another eight over-the-counter tests through Medicare?

This effort will cover up to eight over-the-counter COVID-19 tests per calendar month beginning April 4, 2022. If you have eight of these tests in the current calendar month, you must wait until the beginning of the following calendar month to acquire more. This project, for example, will provide eight over-the-counter COVID-19 tests on April 14, 2022. After May 1, 2022, you will not be eligible for another round of eight free COVID-19 tests.

Is it possible to claim a test that I paid for myself?

No. Medicare will deny a beneficiary’s claim for a COVID-19 over-the-counter test. You should, however, check to see if your pharmacy or healthcare provider is part of the project. They will submit a claim to Medicare on your behalf for the over-the-counter test.

When will this project come to an end?

As long as the COVID-19 PHE remains in effect, Medicare will cover up to eight free over-the-counter COVID-19 tests every calendar month.

If my family members do not have Medicare, may they get free COVID-19 tests?

Every home in the United States is eligible to receive four free COVID-19 tests delivered to their door by the United States Postal Service. In addition, COVIDtests.gov allows you to order four at-home tests for free and deliver them to your home. You can also contact 1-800-232-0233 for help in English, Spanish, and more than 150 other languages if you have trouble accessing the internet or need further assistance placing an order. This phone number is available from 8 a.m. to midnight ET, seven days a week. In addition, a TTY line (1-888-720-7489) is available to assist hard-of-hearing callers.

What additional options do you have for getting COVID-19 tests for yourself and your family?

  • COVID-19 tests are available at no cost through health care professionals at over 20,000 testing locations around the country.
  • When a doctor or other health care provider requests PCR and antigen testing for you, you can get them free from a lab.
  • During the COVID-19 PHE, you can have a free lab test administered by a healthcare specialist.

 

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Dennis L. Hernandez
I am a medical biller, a blogger and have 20 years of experience in medical billing, medical billing management, and medical assistant. My background includes positions as a clinical medical assistant, medical records technician, medical office manager, biller, and coder.

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