Michael Storm, a retired Army captain, wanted to take advantage of a new federal plan that requires health insurers to cover up to eight home coronavirus tests per month.
When the man from Tuscaloosa, Alabama, tried to get the home tests from his local pharmacy last week, he discovered what tens of millions of Americans will soon discover: his federal health insurance provider does not cover over-the-counter tests.
Storm is covered by Tricare, a Department of Defense health care program that serves millions of active-duty and retired military families. The home tests will also not be covered by Medicare, the nation’s health-care program that covers more than 61 million people, the majority of whom are elderly.
The Biden administration’s mandate, which went into effect on January 15, requires those with private health insurance to receive a monthly allotment of free tests. Despite this, health experts say the ambitious federal plan to rapidly expand home testing will be difficult due to the country’s fragmented health-care system.
The insurance reimbursement is distinct from the new federal website, CovidTests.gov, which allows Americans to order four free kits per address and have them delivered by the United States Postal Service. However, if a family of four experienced a COVID outbreak, those free tests would be quickly used. The insurance-funded strategy provides people with a continuous supply of tests.
Some groups have coverage gaps, according to federal officials.
Meena Seshamani, a deputy administrator at the Centers for Medicare and Medicaid Services, said in a statement that the agency is “assessing any options to increase testing availability for seniors.”
According to Corlette, Medicare was not included in the home test mandate because the Biden administration did not believe it had clear legal authority to pay for over-the-counter tests.
On Monday, a bipartisan group of 19 senators, mostly Democrats, urged the Biden administration to expand home test coverage to Medicare. The lawmakers stated in a letter to US Department of Health and Human Services and CMS officials that Medicare recipients, primarily older Americans but also some people with disabilities, are at higher risk for COVID-19 complications, and the lack of home-test coverage “leaves them on the hook for potentially significant out-of-pocket costs.”
In addition to the four free tests per family available through CovidTests.gov, Seshamani stated that seniors have access to more than 20,000 free testing locations across the country. Medicare recipients also can get free laboratory-based tests from doctors, clinics, pharmacists or other authorized testing sites.
Since August, Medicaid, the health-care program that covers over 83 million low-income families and children through the Children’s Health Insurance Program, has allowed payments for tests. The American Rescue Plan Act authorized Medicaid coverage of home tests.
According to Jack Rollins, director of federal policy at the National Association of Medicaid Directors, many states are still working out the details of how to smoothly implement the plan for Medicaid providers and beneficiaries.
According to Rollins, one significant difference between Medicaid and private insurers is that Medicaid programs are not permitted to reimburse recipients who purchase home tests. As a result, state Medicaid programs are working to determine billing details for pharmacies and other test providers. According to Robin Rudowitz, the Kaiser Family Foundation’s director of the Medicaid and uninsured program, it’s unclear how many Medicaid enrollees have taken advantage of the free home tests.
Even if state Medicaid programs have authorized these tests, “I’m not sure enrollees are aware of that option,” Rudowitz said.
The Medicaid option became available this fall, after retailers and online stores frequently ran out of home tests due to the delta and omicron variants’ spiraling demand.
According to Rudowitz, Medicaid recipients may be more likely to receive home tests from community health centers and other distribution sites such as libraries, fire stations, and public health departments.
Storm contacted a veterans group after his home test purchase was denied at a pharmacy and discovered that home-testing reimbursement does not apply to retirees like himself. He chose to spend his own money on rapid antigen testing kits. He can afford it, but he is concerned about military families and Medicare recipients who cannot.
He understands the importance of quickly implementing a program as the omicron variant sweeps the country, but he would have preferred that the federal government first address coverage gaps.