President Joe Biden's administration is facing pressure from lawmakers and advocates to close a major gap in its COVID-19 strategy, which leaves Medicare beneficiaries without coverage of at-home tests.
Medicaid and Children's Health Insurance Plan enrollees are eligible for no-cost at-home COVID-19 tests under the American Rescue Plan Act. Households with private health insurance now can be reimbursed for at-home tests under a Centers for Medicare and Medicaid Services policy that took effect this month.
Although these actions could ease access to at-home testing for hundreds of millions of U.S. residents, they exclude 64 million Medicare beneficiaries who, by virtue of being older or having disabilities, are especially vulnerable to the novel coronavirus. A separate Biden initiative to distribute 1 billion at-home tests via the postal service is inadequate on its own for those with Medicare, lawmakers and advocates contend.
A growing number of congressional Democrats is urging the administration to find a way to provide at-home tests to Medicare enrollees as the pandemic persists.
"We strongly encourage you to extend coverage to Medicare," Sen. Debbie Stabenow (Mich.) and 18 other Senate Democrats wrote in a letter to Health and Human Services Secretary Xavier Becerra Monday. Under the current policies, Medicare enrollees are "on the hook for potentially significant out-of-pocket costs," the senators wrote.
The letter's signatories include a number of influential Democrats, including Stabenow, who chairs the Democratic conference's policy committee and the Senate Agriculture Committee, and conference vice chairs Elizabeth Warren (Mass.) and Mark Warner (Va.), who also helms the Intelligence Committee.
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Among the 19 senators who sent the letter are 10 of the 11 Democrats on the Finance Committee, which has jurisdiction over Medicare, including health subcommittee chair Stabenow, Warren and Warner. Only Chair Ron Wyden (D-Ore.) is missing.
The leaders of powerful Senate panels also joined the letter, such as Banking Committee Chair Sherrod Brown (D-Ohio), Foreign Relations Committee Chair Robert Menendez (D-N.J.), Armed Services Chair Jack Reed (D-R.I.) and Budget Committee Chair Bernie Sanders (I-Vt.). All those except Reed also sit on the Finance Committee.
This push from Senate Democrats follows recent pressure from House members, including a letter more than 100 lawmakers wrote to Becerra on Thursday.
"We urge HHS to ensure that Medicare beneficiaries have sustained access to at-home COVID-19 testing at no cost through the Medicare program," Reps. Tom Malinowski (D-N.J.), Kim Schrier (D-Wash.) and the other legislators wrote. Two Republicans signed along with dozens of Democrats: Reps. Brian Fitzpatrick (Pa.) and Peter Meijer (Mich.).
New Jersey Democratic Reps. Bill Pascrell and Scott Peters delivered a separate letter to Biden on Jan. 14. "Without comparable benefits available through the Medicare program, nearly 20% of the population would be made to pay out-of-pocket for COVID-19 tests, and therefore should not be expected to test with the same desired frequency," they wrote.
Key voices off Capitol Hill also are pressing the Biden administration to address the testing coverage gap.
"Although Medicare beneficiaries have access to COVID tests at no cost, they have to jump through hoops to get them," said AARP lobbyist Andrew Scholnick. "We're confident CMS can find a way to provide access to free at-home tests," he said.
"This really needed to happen a couple months ago. It's frustrating," said Natalie Kean, a senior staff attorney at Justice in Aging. "We are hopeful that the administration is working on a solution and we'd just like them to roll it out as soon as possible."
Adding Medicare coverage of at-home tests without new legislation could prove tricky. The program generally doesn't cover over-the-counter medical products, although some Medicare Advantage plans do so as a supplemental benefit.
There may be ways to square this circle, advocates contend.
The administration could be "creative," said Gretchen Jacobson, vice president of Medicare at the Commonwealth Fund. "They could do something like they're currently doing for everyone with four free tests. You could have a portal of additional tests just for people on traditional Medicare, based upon your Medicare ID or something of that sort."
One lobbyist working on this issue argued Medicare could cover at-home tests under the ongoing public health emergency declaration. For example, CMS could allow clinicians and pharmacists to bill Medicare when they dispense at-home tests, said the lobbyist, who declined to be identified while discussions with the administration continue.
So far, CMS isn't revealing what, if any, policies may be under consideration. "While at this time original Medicare cannot pay for at-home tests, testing remains a critical tool to help mitigate the spread of COVID," a spokesperson wrote in an email. "We continue to explore the best ways to provide critical resources that will keep Medicare beneficiaries safe and healthy."
Meanwhile, health plans are pushing back on the administration's use of insurance to cover COVID-19 testing for non-medical reasons and say HHS shouldn't duplicate this approach in Medicare and Medicare Advantage.
"It's simply not working," said Ceci Connolly, president and CEO of the Alliance of Community Health Plans, which represents not-for-profit health insurers, including some Medicare Advantage carriers. "For the administration to expand a program that's not working right now has the potential to cost a lot of money in the coming weeks and months and is likely to really confuse and frustrate a lot of people," she said.
Instead, the federal government needs a comprehensive national testing strategy that prioritizes tests for people who are unvaccinated, have been exposed to COVID-19 or are particularly susceptible to sever illness, Connolly said.