Senators push for Medicare to reimburse at-home COVID-19 tests like commercial insurers

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A group of mostly Democratic senators is pushing the Biden administration to require that Medicare cover at-home COVID-19 tests for seniors, much like commercial insurers do for their customers.

Nineteen senators, led by Senator Debbie Stabenow (D-MI), chairwoman of the Senate Finance Committee Health Care Subcommittee, sent a letter to the administration this week advocating for such a move, praising the requirement that most private insurance companies cover the cost of up to eight over-the-counter COVID-19 tests per person – and arguing that this reimbursement be extended to the 61 million Americans enrolled in original Medicare or private Medicare Advantage plans.

“Seniors and people with disabilities enrolled in Medicare are at the highest risk of severe illness from COVID-19, and people over 65 account for nearly three-quarters of all deaths from the virus,” the lawmakers said. “The current policy leaves them on the hook for potentially significant out-of-pocket costs. We share your commitment to making sure Medicare enrollees receive the highest quality healthcare, including access to free at-home rapid COVID-19 testing, and look forward to working with you to address this issue.”

Along with vaccination, the senators framed the widespread availability of free tests as a means of eventually ending the pandemic. A year ago, they said, there were no at-home rapid tests on the market. Today, hundreds of millions are benign distributed across the U.S., “including the Administration’s purchase of 500 million tests with funding included in the American Rescue Plan, and the planned purchase of 500 million more,” the lawmakers wrote.

The current policy leaves seniors on the hook for potentially significant out-of-pocket costs, the senators said.

Along with Stabenow, today’s letter was signed by: Michael Bennet (D-CO), Richard Blumenthal (D-CT), Sherrod Brown (D-OH), Bob Casey (D-PA),  Ben Cardin (D-MD),  Tammy Duckworth (D-IL),  Kirsten Gillibrand (D-NY), Maggie Hassan (D-NH), Chris Van Hollen (D-MD),  Angus King (ME), Amy Klobuchar (D-MN), Bob Menendez (D-NJ), Jack Reed (D-RI), Bernie Sanders (I-VT),  Tina Smith (D-MN), Mark Warner (D-VA),  Elizabeth Warren (D-MA) and Sheldon Whitehouse (D-RI).

WHAT’S THE IMPACT

Because of funding from the Defense Production Act, production of rapid tests, including at-home tests, has increased. There are now at least eight at-home tests on the market. Starting this month, health plans began covering at-home tests for the 150 million Americans with private health insurance; for those not covered by private insurance, President Biden said in December that the federal government will make free tests available. 

This is on top of the 20,000 sites already around the country, such as pharmacies, where someone can go in and get tested for free and get vaccinated.

THE LARGER TREND

As of January 15, most people with a health plan can go online or to a pharmacy or store to purchase an at-home over-the-counter COVID-19 diagnostic test authorized by the U.S. Food and Drug Administration at no cost, either through reimbursement or free of charge through their insurance, according to the Centers for Medicare and Medicaid Services. This applies to individuals who have purchased their own health plan or have health insurance through their jobs.

The test will either be free directly at the point of sale, if the health plan provides for direct coverage, or by reimbursement if members are charged for the test. Receipts need to be submitted to file a claim with the insurance company for reimbursement. 

If a plan has set up a network of preferred providers to obtain a test with no out-of-pocket expense, a member can still obtain tests from other retailers outside that network. Insurance companies are required to reimburse at a rate of up to $12 per individual test (or the cost of the test, if less than $12).

Matt Eyles, president and CEO of AHIP, said: “Health insurance providers will work as quickly as possible to implement this guidance in ways that limit consumer confusion and challenges. While there will likely be some hiccups in early days, we will work with the administration to swiftly address issues as they arise.”
 

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