While most of Medicare's 63 million beneficiaries are still waiting for no-cost at-home COVID-19 tests, some Medicare Advantage carriers already cover them.
Medicare Advantage plans often include supplemental benefits that pay for things the traditional fee-for-service Medicare program doesn't, including over-the-counter health products. And while big players such as Humana, Cigna and CVS Health's Aetna aren't yet covering OTC COVID-19 tests, competitors including UnitedHealthcare, Kaiser Permanente and SCAN Health Plan are. Those insurers make tests available either as part of their benefit packages or by reimbursing pharmacies for dispensing kits.
Fallon Health, a regional insurer in Massachusetts, for example, will retroactively cover all COVID-19 tests purchased by its 12,500 Medicare Advantage members after Jan. 5. By paying for the tests, the insurer believes it can keep its older enrollees out of emergency departments, improve patient outcomes and decrease costs.
"The goal is to reduce the incidence of the COVID infections," said Dr. David Brumley, Fallon Health's interim chief medical officer. "If there's less transmission, and people get sick less often because they're testing, that's obviously a benefit." The insurer intends to add COVID-19 tests to its pharmacy benefit so customers can obtain them at no cost from drugstores, he said. The insurer and UnitedHealth Group's OptumRx, its pharmacy benefit manager, are still working out details such as how much to pay for the kits.
Fallon Health is ahead of an industry preparing to incorporate over-the-counter COVID-19 tests into their benefits.
The Centers for Medicare and Medicaid Services unveiled a policy this month providing Medicare coverage for at-home COVID-19 tests starting this spring, following pushback from lawmakers and advocates. Previous federal policies required Medicaid, the Children's Health Insurance Plan and private health insurance companies to cover tests.