April 17, 2023

TAHC Press Release: 3.5 Million Medicare Beneficiaries Receive No Cost Over-The-Counter COVID-19 Tests in the Second & Third Quarter of 2022

 An analysis of Medicare claims data by McDermott+Consulting shows that nearly 31.5 million at-home COVID-19 tests were distributed to 3.5 million Medicare beneficiaries from April through September of 2022 at no cost to beneficiaries. During this time, the number of tests distributed and the number of beneficiaries receiving them increased each month as the program became more popular. Pharmacies distributed 95% of tests. 

Table: At Home Covid-19 Tests Billed Via CMS-1500 Claims

Tests were distributed across all 50 states plus the District of Columbia and Puerto Rico, reaching over 3 million beneficiaries living in urban areas and over 400,000 rural beneficiaries. Overall, the program is widely used with 5% of Medicare beneficiaries having acquired at least one at-home COVID-19 test through Medicare Part B during the first 6 months of the program.

Percent of Medicare Beneficiaries That Have Acquired At Least One No-Cost At-Home COVID-19 Test Between April and September 2022 Through Medicare Part B by State

Map: Percent of Medicare Beneficiaries That Have Acquired At Least One No-Cost At-Home COVID-19 Test Between April and September 2022 Through Medicare Part B by State

“Our data continues to show that there is a high demand for at-home COVID-19 tests, and that the Biden Administration’s demonstration provides a meaningful benefit to our nation’s seniors,” said Amy Kelbick, a representative for the Testing at Home Coalition. “Yet, the program is set to end on May 11 and most seniors are unaware that they will have to pay entirely out-of-pocket to maintain access,” she continued.

The Medicare demonstration program to cover at-home tests at no-cost to beneficiaries is expected to end when the COVID-19 public health emergency (PHE) ends, despite concerns from many Members of Congress. Senate Finance Chairman Ron Wyden (D-OR) and Senator Bob Casey (D-PA) recently led a letter to HHS outlining their concerns that this coverage is ending. This follows outreach to CMS from thirty-two House Democrats led by Rep. Bill Pascrell (D-NJ) and Rep. Scott Peters (D-CA), and from Congresswoman Anna Eshoo (D-CA),Ranking Member of the House Energy and Commerce Health Subcommittee. In addition, AARP and the Medicare Rights Center both sent letters to CMS expressing their support for the program and asking for details on CMS’s authority and plans to continue to make free at-home tests available to Medicare beneficiaries beyond the PHE.

Additional Background Information:

On April 4, 2022, the Biden-Harris Administration announced that Americans with Medicare Part B, including those enrolled in a Medicare Advantage plan, would have access to Food and Drug Administration approved, authorized, or cleared over-the-counter COVID-19 tests at no cost.

This marked the first time in history where Medicare has paid for an over-the-counter product. The initiative allows these beneficiaries to have access to up to eight tests per month, at no cost, from participating and eligible pharmacies or health care providers.

The Centers for Medicare and Medicaid Services established this program using authority available to the agency through 42 U.S. Code § 1395b–1, which authorizes the agency to, among other things, develop and implement projects to test new Medicare payment methods.

This demonstration began April 4, 2022 and will continue until the COVID-19 public health emergency ends, unless extended by the Centers for Medicare and Medicaid Services.