Biden Administration Explores Ways to Cover Covid-19 Tests for Medicare Enrollees

But the requirement that insurers cover the tests doesn’t apply to the more than 76 million people on Medicare because under federal law, the program typically doesn’t cover self-administered diagnostic tests. The administration’s policy options to expand coverage quickly may be limited.

Consumer advocacy groups and some Democratic lawmakers are pressing the administration to take action, saying seniors covered by Medicare should get free tests because they are most vulnerable to severe infection.

“Over-the-counter tests have not been paid for as a Medicare benefit, but we’re going through the process now to explore options and work through statutory and regulatory issues as we drive toward solutions,” said Dr. Meena Seshamani, director of the Center for Medicare and deputy administrator for the Centers for Medicare and Medicaid Services.

Making diagnostic tests more abundant and affordable could help curb the spread of Covid-19 because people who are identified as infected can quickly isolate and help reduce transmission, as well as potentially get treatment. But tests have been hard to come by amid a shortage and the rapid spread of the Omicron variant.

“I am disappointed that the reimbursement option for eight additional at-home tests per month per person only applies to those with private or group health insurance,” Democratic Rep. Anna Eshoo of California said in a recent letter to Health and Human Services Secretary Xavier Becerra.

Democratic Sen. Richard Blumenthal of Connecticut also called on HHS in a separate letter to cover all FDA-authorized over-the-counter at-home rapid tests for its beneficiaries.

The policy requiring free coverage of tests for people on private insurance falls under 2020 Covid-19 legislation that requires group health plans to provide Covid-19 testing with no cost sharing, administration officials say.

But Medicare coverage is largely determined by statute. For Medicare to cover a specific item or service, it has to fall into an approved benefit category, such as preventive services.

“They’d be violating statute if they paid for something,” said Mark Polston, a healthcare team lawyer at King & Spalding in Washington, D.C., and a former deputy associate general counsel at HHS. “As a general matter, Medicare doesn’t cover screening tests.”

Congress could make a determination that Medicare cover the rapid tests, but advocates said the administration shouldn’t wait for legislative action because that could take too long.

“I wish people with Medicare weren’t left out,” said Casey Schwarz, senior counsel for education and federal policy at the Medicare Rights Center. “People over 65 and the disabled are at higher risk, and one of the important things is early detection and early treatment.”

The administration may be able to issue an emergency rule, guidance or take other action to expand coverage of tests for the Medicare population, said Judy Waltz, a healthcare partner at the Foley & Lardner law firm. “Whether they can make an interpretation that expands coverage is a question,” she said.

The administration has stressed that people covered by traditional Medicare can get Covid-19 diagnostic tests performed by a laboratory, such as PCR and antigen tests, covered with no beneficiary cost sharing when the test is ordered by a healthcare professional. They can also get a single lab-performed test without cost sharing per patient a year without an order.

Medicare Advantage plans, which are administered by private insurers, may offer coverage and payment for more at-home over-the-counter Covid-19 tests.

Write to Stephanie Armour at [email protected]