May 11, 2023 – WASHINGTON D.C. As of midnight tonight, over-the-counter (OTC) COVID-19 tests will no longer be covered by Medicare, leaving beneficiaries who can’t pay out-of-pocket with limited access. Yet, only 24% of Americans over the age of 65 know that coverage for these tests is ending. What’s more, 7 out of 10 Americans over the age of 65 expect to stop using at-home tests when coverage for them ends.
There’s no doubt that older Americans are benefitting from the availability of OTC COVID-19 diagnostic tests. In fact, the Centers for Medicare and Medicaid Services (CMS) stated that a total of 101 million OTC tests were provided to 8 million Medicare beneficiaries as of April 2023.
“There’s every indication that CMS’s demonstration program is helping millions of older Americans. So it’s unfortunate that CMS has chosen to end this successful program,” said Amy Kelbick, a representative for the Testing at Home Coalition. “Going forward, it’s unclear how many seniors will be able to afford to pay for OTC tests and how many will continue to test when needed.”
CMS began making OTC COVID-19 diagnostic tests available to Medicare beneficiaries through a demonstration program launched in April 2022. CMS’s statutory demonstration authority allows the agency to, among other things, develop and implement novel experiments, such as coverage for self-administered tests. Further, when CMS ends this demonstration, the Medicare program will provide no alternative coverage for OTC COVID-19 tests. This authority is unrelated to the PHE, but CMS has indicated that it intends to end the demonstration program when the PHE concludes. However, the need for affordable OTC COVID-19 tests will not end there.
There is significant support in Congress for extending Medicare coverage of OTC tests. Senate Finance Chairman Ron Wyden (D-OR) and Senator Bob Casey (D-PA) recently led 16 other Senate Democrats in sending a letter to HHS outlining their concerns that Medicare 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.
