Covid Testing, what’s covered and what’s not?
The COVID-19 pandemic has affected millions of people worldwide, and testing has been a critical tool in managing the spread of the virus. In the United States, Medicare has been a key player in providing coverage for COVID-19 testing since the beginning of the pandemic. In this blog, we will explore what Medicare has covered regarding COVID-19 testing over the years.
COVID-19 Testing in 2020
In 2020, the COVID-19 pandemic hit the United States hard, and testing was essential in identifying and containing the virus's spread. In response, the Centers for Medicare and Medicaid Services (CMS) announced that Medicare would cover COVID-19 testing for beneficiaries in early March 2020. The coverage was initially limited to FDA-authorized laboratory tests, and the tests were conducted in healthcare settings or temporary testing sites.
In April 2020, CMS expanded coverage to include COVID-19 tests that were developed in-house by laboratories. This change allowed hospitals, clinics, and other healthcare facilities to develop their own COVID-19 tests, provided they met the FDA's standards. The tests could be conducted in-house, and the results could be reported to public health departments as required by law.
In May 2020, CMS announced that Medicare would also cover serology tests for COVID-19. Serology tests, also known as antibody tests, detect the presence of antibodies in a person's blood. These tests were important in determining whether someone had been infected with the virus in the past.
COVID-19 Testing in 2021
As the COVID-19 pandemic continued into 2021, Medicare's coverage for COVID-19 testing evolved to meet the changing needs of beneficiaries. In January 2021, CMS announced that Medicare would cover COVID-19 tests that were self-administered by beneficiaries at home. This change allowed beneficiaries to test themselves for COVID-19 without leaving their homes, reducing the risk of exposure to the virus.
In February 2021, CMS announced that Medicare would also cover COVID-19 tests that were required for international travel. This change allowed beneficiaries who were traveling internationally to get tested for COVID-19 before their trip and have the cost of the test covered by Medicare.
Covid testing in 2022
With the prevalence of the OMICRON variant and many more Americans starting to travel, demand for COVID testing has skyrocketed. Although at-home test kits give a convenient alternative to standing in line, there’s a lot of confusion around what’s covered. Below is a condensed overview of how COVID testing is covered under current Medicare guidelines in 2022.
Within the United States:
In-person: In-person COVID testing at testing sites or ordered by a licensed provider still remains no-cost in almost all scenarios regardless of the health plan.
At-home test kits: Started in Jan 15, 2022 individuals on non-Medicare insurance had at least 8 at home test kits covered by their plan. Individuals paid for them upfront and submit a reimbursement form or have the pharmacy/retailer bill their insurance if this option is available.
However, Medicare was not required to cover home test kits purchased at a retail pharmacy. Some Medicare Advantage plans covered home test kits as part of their over-the-counter benefit. Free test kits were available through local health clinics.
Internationally:
Unfortunately, Medicare typically didn’t cover non-symptomatic routine screening outside of the country. Many reports of individuals sadt that they were having to pay for their own COVID tests when traveling to or from other countries.
What Has Changed About Covid Coverage in 2023?
On May 11, 2023, the public health emergency (and national emergency) declarations will end. This means that some changes will occur with regards to health policies. Regarding COVID-19 vaccines, nothing will change as they will remain free to all individuals regardless of insurance coverage, as long as federal supplies last. At-home COVID tests may become more expensive for insured individuals, as traditional Medicare will no longer provide free at-home tests, although some insurers may voluntarily cover them. Insured individuals may face cost-sharing for COVID treatments, but those purchased by the federal government will remain free to all. The FDA's emergency use authorizations for COVID-19 vaccines, treatments, and tests will continue to be in effect. Additionally, some flexibilities associated with providing health care via telehealth may be removed.
Final Thoughts
In conclusion, the COVID-19 pandemic has significantly impacted people worldwide, and testing has been crucial in managing the spread of the virus. Medicare has played a crucial role in providing coverage for COVID-19 testing in the United States. Over the years, Medicare's coverage for COVID-19 testing has evolved to meet the changing needs of beneficiaries, from in-person testing to self-administered testing and testing required for international travel. However, with the prevalence of the OMICRON variant and increasing demand for testing, Medicare's coverage for at-home test kits has changed in 2022. As of May 11, 2023, some changes will occur with regards to health policies, including the end of the public health emergency declarations, which may impact the cost and coverage of COVID-19 tests and treatments. Nonetheless, it is essential to continue to follow public health guidelines and stay informed of the latest updates regarding COVID-19 testing and Medicare coverage.