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WASHINGTON -- Can your Medicare patients get reimbursed for buying at-home rapid COVID tests? Sorry, no -- but we're working on changing that, say Medicare officials.

Although the Biden administration mandated that private insurers must reimburse patients for purchasing up to eight at-home tests per month, they did not mandate the same thing for traditional Medicare. However, "CMS [the Centers for Medicare & Medicaid Services] is exploring ways to expand testing options for Medicare beneficiaries," an agency spokesperson said in an email.

"While at this time original Medicare does not pay for over-the-counter, at-home COVID-19 tests, CMS is exploring ways that Medicare can cover them as we look to overcome a number of statutory and regulatory hurdles," the spokesperson said. "We recognize testing remains a critical tool to help mitigate the spread of COVID-19, and we are committed to providing resources to keep Medicare beneficiaries safe and healthy."

The spokesperson noted that Medicare beneficiaries can get four free rapid tests sent to their homes by going to the website. They also can get free PCR tests at a lab when the test is ordered by a physician, non-physician practitioner, or pharmacist, and they can get a free rapid test at any of nationwide. Some Medicare Advantage plans may also cover at-home COVID tests, so Medicare Advantage enrollees should check with their plan, the spokesperson said.

The reason that traditional Medicare doesn't cover the tests is because current law doesn't provide for it, explained Casey Schwarz, JD, senior counsel for education and federal policy at the Medicare Rights Center, a consumer service and advocacy organization for Medicare beneficiaries. "We want CMS to expand the coverage if they can -- if they don't think they can, then Congress needs to act, but we think that that probably is something that CMS can do," she said in a phone interview.

However, whatever they do probably won't look like the coverage for those with private insurance, she added. That's because "the way Medicare is structured is different than private insurance. Individuals don't submit claims to Medicare, so the mechanism that exists in private plans for people to buy a test kit at a pharmacy or grocery store and submit a receipt -- that doesn't exist in Medicare."

In terms of over-the-counter-type (OTC) products, Medicare does cover diabetes patients' glucose test strips under the Part B program, but those are paid for under a provision for covering durable medical equipment (DME). The strips are used in conjunction with a device that is considered DME because it can be reused, Schwarz said -- something that is not the case with the disposable COVID test kits. Even with the test strips, a healthcare provider has to write the patient an order for the test strips, and then the patient fills the order -- often through the mail -- with a DME company, not a retail pharmacy, although some DME firms are co-located with pharmacies.

Covering the test kits under that DME provision would require a waiver of the "durability" aspect, she said, adding that "there are some other folks who have proposed other mechanisms for Part B coverage. Most of them would probably require some communication with a provider, whether a prescriber or pharmacist."

The lack of at-home test coverage for Medicare beneficiaries has not gone unnoticed on Capitol Hill. "Seniors and people with disabilities enrolled in Medicare are at the highest risk of severe illness from COVID-19, and people over 65 account for nearly three-quarters of all deaths from the virus," wrote eight Senate Democrats sent Monday to Health and Human Services Secretary Xavier Becerra and CMS Administrator Chiquita Brooks-LaSure.

"The current policy leaves them on the hook for potentially significant out-of-pocket costs. We share your commitment to making sure Medicare enrollees receive the highest quality healthcare, including access to free at-home rapid COVID-19 testing, and look forward to working with you to address this issue." The letter was signed by senators Debbie Stabenow (D-Mich.), Sherrod Brown (D-Ohio), Jack Reed (D-R.I.), Richard Blumenthal (D-Conn.), Tammy Duckworth (D-Ill.), Sheldon Whitehouse (D-R.I.), Ben Cardin (D-Md.), and Robert Menendez (D-N.J.).

Sen. Blumenthal also wrote a to Brooks-LaSure last Friday on the issue. "As shortages of tests are exacerbated by the Omicron variant, it is more critical than ever that individuals have affordable access to COVID-19 diagnostic tests," he wrote. "I continue to request that the administration take all steps necessary to alleviate this shortage and make COVID-19 tests more accessible to all who need them. A critical step in this effort is expanding free coverage of OTC at-home COVID-19 tests to individuals with Medicare coverage. I urgently call on you to take this necessary step."

Asked whether the senator was considering introducing any legislation on the issue, a spokesperson for Blumenthal did not answer directly but said in an email that the senator believes Medicare should cover the tests and that his office will be following the issue closely.

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