May 2, 2023

Avisery Alert: Updates to Coverage for COVID-19 Tests and CMS Consumer Factsheet



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


Avisery by AgeOptions provides tools and support to professionals serving older adults and people with disabilities, enabling them to help their clients access healthcare coverage that allows them to thrive as they age. To sign up for our Avisery email list and receive information on upcoming trainings, webinars and more, please click here.

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