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Dear Avisery Members,
The Centers for Medicare and Medicaid Services (CMS) has published a new factsheet that explains how Medicare and Medicaid will cover COVID-19 tests after the Covid-19 Public Health Emergency (PHE) ends on May 11th, 2023.
Background
The Medicare program normally does not cover over-the-counter (OTC) tests as a benefit. However, during the PHE, CMS allowed Medicare to cover up to eight OTC COVID-19 tests per month with no out-of-pocket cost to the beneficiary. During the PHE, Medicare beneficiaries have also been allowed to receive one COVID-19 laboratory test without a doctor’s order (in addition to physician-ordered tests). Under Medicare, laboratory COVID-19 tests have been covered at 100% during the PHE (I.e., with no patient co-pay).
Beginning May 12th, 2023, Original Medicare beneficiaries will no longer have coverage for OTC tests. They will continue to receive 100% coverage for COVID-19 laboratory tests, but only when ordered by a physician. Medicare Advantage (MA) beneficiaries should check with their plan to know if coverage for OTC COVID-19 tests will end and what the cost-sharing amount for a physician-ordered laboratory test will be.
Medicaid members will continue to receive coverage for OTC COVID-19 tests, as well as laboratory tests, through at least September 30th, 2024.
Access the factsheets in English and Spanish here:
https://www.cms.gov/files/document/covid-over-counter-test-coverage.pdf (English)
https://www.cms.gov/files/document/covid-over-counter-test-coverage-spanish.pdf (Spanish)
As always, if you have any questions, please do not hesitate to contact us at avisery@ageoptions.org or call 708-628-3440.
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