The Centers for Medicare and Medicaid Services announced that starting Monday, during the COVID-19 public health emergency, Medicare Part B beneficiaries will receive $12 per home test.

Beneficiaries are eligible to take up to eight free at-home tests per calendar month. Medicare Advantage enrollees can get eight free tests that are not covered by their existing plan, plus any Additional tests Their plans cover as supplemental benefits.

This coverage is only available to beneficiaries enrolled in Medicare Part B, which primarily covers outpatient care. According to CMS, more than 59 million people fall into this category. Beneficiaries with only Medicare hospital coverage or Part A are not eligible for home testing coverage.

Participating pharmacies will provide free COVID-19 testing for Medicare beneficiaries, Include CVS, Costco Pharmacy, Walgreens and Walmart. The program is voluntary, and non-participating pharmacies and providers can continue to sell over-the-counter tests, including to Part B participants.

Other eligible providers, such as doctors, skilled nursing facilities, and independent laboratories, can provide testing and bill Medicare. Medicare will not cover home testing if the provider tests while in the hospital.

Participation begins when a provider submits a test request to Medicare. No separate engagement agreement is required.

Medicare will pay providers a national flat rate of $12 per test. If a provider’s typical rate is less than $12 per test, Medicare will reimburse the lower rate.

Claims will be processed in the order in which they were submitted. Providers cannot use roster bills (a way to submit multiple claims at once) for home COVID testing. CMS cannot process over-the-counter testing claims submitted directly by beneficiaries.

CMS recommends that providers offer tests to patients only when they request it. The agency also said providers should properly document patient testing requests. CMS may request documentation, and if not, the agency can recover money and take other administrative action. Fact Sheet.

Tests previously purchased by the beneficiary cannot be reimbursed.

Content Management System Announced in February It will cover home testing for Medicare beneficiaries pressure From Capitol Hill and advocating for older Americans to correct the fact that free home COVID-19 testing is nearly impossible for those enrolled in Medicare. private insurance company They have had to give enrollees eight free home tests since January. Some Medicare Advantage plans cover testing for COVID-19 at home, but Medicare generally does not pay for over-the-counter health products.

Dr. Meena Seshamani, Director and Deputy Administrator of the CMS Center for Health Insurance, in a statement Press Releases. “[T]His initiative will significantly increase testing opportunities for Americans most at risk of contracting COVID-19 and will provide valuable information for future payment policies to support accessible, comprehensive, person-centred health care. “

CMS confirmed that the agency used the Social Security Administration’s Demonstration Program authorization to allow temporary coverage of home COVID-19 testing. It allows the agency to test payment models to see if they make Medicare more efficient. Medicare’s hospice benefits began with a demonstration program under the authority.

Tricia Neuman, KFF senior vice president and executive director of the organization’s Medicare Policy Program, said using a demonstration program may be the path of least resistance to quickly covering home testing through Medicare.

“In some ways, the law has not been changed, the minister’s hands are tied, so there are not many options. This is a pandemic where people are getting sick and dying, and while hospitalizations and death rates are falling, there is a concern about transmission. It’s still there,” Newman said.