May 3, 2023 – WASHINGTON D.C. Despite the ongoing success of its program to provide Medicare beneficiaries with access to at-home COVID-19 tests at no out-of-pocket cost, the Centers for Medicare and Medicaid Services (CMS) is set to end this program on May 11 to coincide with the end of the Public Health Emergency (PHE). A poll conducted by the Testing at Home Coalition (TAHC) found that 72% of U.S. adults relied on at-home tests over the past two years. However, only 24% of Americans over the age of 65 are aware that Medicare intends to stop covering these tests after the PHE ends.
An analysis of Medicare claims data by McDermott+Consulting shows that nearly 31.5 million over-the-counter (OTC) COVID-19 tests were distributed to 3.5 million Medicare beneficiaries from April through September of 2022 at no cost to Medicare 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. CMS recently stated that they distributed 101 million at-home tests to approximately 8 Medicare million beneficiaries since April 2022. It is clear that this program is popular and widely relied upon even in the short time it’s been available.
“Americans have come to rely on OTC tests to test for COVID-19, especially those over 65 who are the most susceptible to severe infection and hospitalization,” said Amy Kelbick, a representative for the Testing at Home Coalition. “But the lack of Medicare coverage for these tests will hinder access and utilization. Our poll found that 70% of those over 65 will likely stop testing if at-home tests are no longer covered by insurance,” Kelbick went on to say.
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. When CMS ends this demonstration, however, the Medicare program will provide no alternative coverage for over-the-counter OTC COVID-19 tests. CMS’s authority to continue this program is unrelated to the PHE, but CMS has indicated that it intends to end the demonstration program when the PHE concludes on May 11. The need for affordable OTC COVID-19 tests will not end there.
There is significant support in Congress for extending access to at-home testing for Medicare beneficiaries. 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.