The Biden Administration’s new mandate that insurers cover the cost of at-home test did not include beneficiaries of Medicare. This is very unfortunate because Medicare recipients are the largest at-risk population.  

The new mandates that private insurers cover the cost of at-home-test – up to eight per enrollee per month. And, because Medicare enrollees are not participant of this mandate, this leaves many afraid of the consequences.   There are about 63.3 million people enrolled in Medicare and the majority of these beneficiaries, 55.1 million, are age 65 or older, and the rest, though younger, are generally people with disabilities. Many of which may have illnesses that leave them very vulnerable to COVID. 

The mandate which took place on January 15th, means that most consumers with private health coverage can buy at-home test at a store or online and either get it paid for upfront by their insurance company by submitting their insurance card or get reimbursed by submitting a claim to their insurer.  

Fortunately, there are still options for Medicare beneficiaries to get access to free COVID test. 

Here are your options:

1. You can order four free tests through Covidtest.gov, a new government website that officially launched on January 15th. This site is available to all households not just Medicare beneficiaries. This is for 4 free at-home test per month/per household. Therefore, you may have to reorder every month.  
2. You can also pick up at-home COVID test for free at Medicare-certified health clinics. 
3. Community health centers. Be aware that currently demand for the test are outpacing supply, so plan accordingly. 
4. For Medicare beneficiaries that are enrolled in a Medicare Advantage plan, reach out to your insurer as they may cover the cost of the at-home Covid test. It’s worth a try. The tests may be covered under a supplemental benefit through the insurer, not a required benefit.  
5. Don’t forget the many testing sites that are offering free Covid testing. Beneficiaries can get the lab-based PCR test, (can take a few days to get back the test results) rapid PCR test, and the rapid antigen test. These sites were really stacked during the Holiday’s, they may be less busy now. A bonus is that many of these sites are drive through, providing you with less exposure to people. 
6. Additionally, if a doctor or other authorized health-care provider orders the test, there is no cost-sharing. 
7. Medicare beneficiaries are allowed to get one lab test for free per year without a doctor’s order. 

It hardly seems fair that Medicare beneficiaries have to jump through more hoops to get access to the free tests. However, this is due to the specific legal authority used to implement the directive. 

It seems that for now, this is how it will continue unless there’s another strong push for Medicare recipients to be included in the mandate. At which point It would require congressional action. For now, Don’t Hold Your Breath!! 

Diahanna Vallentine

Diahanna Vallentine, BCPA, Financial Empowerment Lead

In 2002 Diahanna and her husband received the news that her husband had MGUS, a precursor to Multiple Myeloma. Upon her husband death in 2013, Diahanna immediately decided to make it her mission to help patients and caregivers empower themselves to speak up and to position themselves as partners in their treatment. Diahanna became a Board-Certified Patient Advocate. She is currently the Financial Myeloma Coach for The Myeloma Crowd Foundation.