Skip to main content
Sister Publication Links
  • ESG: THE NEW IMPERATIVE
Subscribe
  • My Account
  • Login
  • Subscribe
  • News
    • Current News
    • COVID-19
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • Transformation
    • People
    • Regional News
    • Digital Edition (Web Version)
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Midwest
    • Northeast
    • South
    • West
  • Digital Health
  • Insights
    • ACA 10 Years After
    • Best Practices
    • Special Reports
    • Innovations
  • Data/Lists
    • Rankings/Lists
    • Interactive Databases
    • Data Points
  • Op-Ed
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
  • Awards
    • Nominate/Eligibility
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Excellence in Governance
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Diversity in Healthcare
    • Women in Healthcare
    • - Luminaries
    • - Top 25 Diversity Leaders
    • - Leaders to Watch
    • - Luminaries
    • - Top 25 Women Leaders
    • - Women to Watch
  • Events
    • Conferences
    • Galas
    • Virtual Briefings
    • Webinars
    • Custom Media Event: ESG Summit
    • Transformation Summit
    • Women Leaders in Healthcare Conference
    • Social Determinants of Health Symposium
    • Leadership Symposium
    • Health Care Hall of Fame Gala
    • Top 25 Women Leaders Gala
    • Best Places to Work Awards Gala
    • Top 25 Diversity Leaders Gala
    • - Hospital of the Future
    • - Value Based Care
    • - Supply Chain Revenue Cycle
    • - Hospital at Home
    • - Workplace of the Future
    • - Strategic Marketing
    • - Virtual Health
  • Listen
    • Podcast - Next Up
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
  • MORE +
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Medicare
February 22, 2022 06:00 AM

Some Medicare Advantage plans already cover at-home COVID-19 tests

Nona Tepper
Maya Goldman
  • Tweet
  • Share
  • Share
  • Email
  • More
    Reprints Print
    covid-test-money_i_i.png
    MH Illustration/Getty Images

    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.

    Download Modern Healthcare’s app to stay informed when industry news breaks.

    The insurer intends to add COVID-19 tests to its pharmacy benefit
    so customers can obtain them at no cost from drugstores.

    Related Articles
    5 takeaways from new at-home COVID-19 test coverage guidelines
    Medicare to cover at-home COVID-19 tests
    Democrats push Biden on Medicare coverage of at-home COVID-19 tests
    Insurers must begin covering at-home COVID-19 tests by Jan. 15
    Private insurers to cover at-home COVID-19 tests

    While CMS hasn't disclosed much about how Medicare test coverage will work, each beneficiary will be entitled to up to eight kits a month. CMS will use Medicare Part B funds to pay for tests regardless whether enrollees have traditional Medicare or Medicare Advantage.

    "The biggest open question right now is just how they're going to roll this out," said Meredith Freed, a senior policy analyst at the Kaiser Family Foundation.

    Alliance of Community Health Plans members started exploring OTC COVID-19 test coverage after the federal government began requiring commercial insurance plans to pay for them, said Dan Jones, vice president of federal affairs at the trade association for not-for-profit health insurance companies. Customers had flooded Medicare Advantage plans' phone lines asking why they couldn't get free tests, which prompted some companies to take action, he said.

    "It's a great case of Medicare Advantage plans being innovative and flexible," Jones said. "When issues pop up with the pandemic or there's another need for services, they're able to be flexible with their supplemental benefits."

    Health insurance carriers that already were covering at-home test for commercial customers have a leg up on peers that weren't, Jones said. So do companies such as UnitedHealth Group that own pharmacy benefit managers, he said. UnitedHealthcare, which has 6.5 million members or 28% of the Medicare Advantage market, estimates that 85% of its Medicare Advantage members have over-the-counter product coverage.

    Medicare Advantage plans currently can provide coverage for OTC COVID-19 tests through supplemental benefits, said Gretchen Jacobson, vice president of Medicare at the Commonwealth Fund. Medicare Advantage benchmark payments and rebates could be higher if net Medicare Part B spending rises because of at-home test reimbursements. That, in turn, would lead to additional costs for beneficiaries and taxpayers, she said.

    "There's basically some financial trade-offs in how you go about doing it," Jacobson said. "Do you then try to take the money out in future years? How do you ensure basically that they're not paying twice for something that's a one-time thing, depending on how long this is going to go on? It gets complicated."

    Correction: This article has been updated to clarify that funds from Medicare Part B will cover the cost of at-home COVID-19 tests. Medicare Advantage carriers will not bear those expenses.

    Related Article
    Entrepreneurs launch Goodbill to target at-home test reimbursement, negotiate hospital bills
    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    medicare-and-money_i.png
    Go-broke dates pushed back for Social Security, Medicare
    NEWS_170629978_AR_0_NMRDBUKNFMDU.jpg
    CMS to adjust Medicare premiums in 2023 due to lower Aduhelm costs
    Sponsored Content
    Daily Dose Newsletter: Sign up to receive a late afternoon weekday roundup of that day’s breaking news and developments in healthcare.
    Get Newsletters

    Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today
    MH Magazine Cover

    MH magazine offers content that sheds light on healthcare leaders’ complex choices and touch points—from strategy, governance, leadership development and finance to operations, clinical care, and marketing.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS

    Our Mission

    Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data.

    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2022. Crain Communications, Inc. All Rights Reserved.
    • News
      • Current News
      • COVID-19
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • Transformation
        • Patients
        • Operations
        • Care Delivery
        • Payment
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition (Web Version)
    • Digital Health
    • Insights
      • ACA 10 Years After
      • Best Practices
      • Special Reports
      • Innovations
    • Data/Lists
      • Rankings/Lists
      • Interactive Databases
      • Data Points
    • Op-Ed
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Awards
      • Nominate/Eligibility
      • 100 Most Influential People
      • 50 Most Influential Clinical Executives
      • Best Places to Work in Healthcare
      • Excellence in Governance
      • Health Care Hall of Fame
      • Healthcare Marketing Impact Awards
      • Top 25 Emerging Leaders
      • Top 25 Innovators
      • Diversity in Healthcare
        • - Luminaries
        • - Top 25 Diversity Leaders
        • - Leaders to Watch
      • Women in Healthcare
        • - Luminaries
        • - Top 25 Women Leaders
        • - Women to Watch
    • Events
      • Conferences
        • Transformation Summit
        • Women Leaders in Healthcare Conference
        • Social Determinants of Health Symposium
        • Leadership Symposium
      • Galas
        • Health Care Hall of Fame Gala
        • Top 25 Women Leaders Gala
        • Best Places to Work Awards Gala
        • Top 25 Diversity Leaders Gala
      • Virtual Briefings
        • - Hospital of the Future
        • - Value Based Care
        • - Supply Chain Revenue Cycle
        • - Hospital at Home
        • - Workplace of the Future
        • - Strategic Marketing
        • - Virtual Health
      • Webinars
      • Custom Media Event: ESG Summit
    • Listen
      • Podcast - Next Up
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • MORE +
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing