Source: Centers for Medicare and Medicaid Services
The COVID-19 Public Health Emergency (PHE) is to end on Thursday, May 11. The ending of the PHE may impact an individual’s coverage of COVID-19 tests. The Centers for Medicare and Medicaid Services (CMS) encourages you to know these changes and share the New Consumer Fact Sheet (English/Spanish) on COVID-19 tests.
Before May 11
If you have any type of health insurance, you can get up to eight over-the-counter tests per month with no out-of-pocket costs. Over-the-counter tests are available in most pharmacies and may also be available online for delivery.
After May 11
Laboratory tests for COVID-19 that are ordered by your physician or other healthcare professional will still be covered with no out-of-pocket costs for people with Medicare. Over-the-counter tests will still be available, but there may be out-of-pocket costs. Coverage of over-the-counter tests may vary by your insurance type, as described below.
What does this mean for Medicare beneficiaries?
Generally, Medicare doesn’t cover or pay for over-the counter products. The demonstration that has allowed Medicare to offer coverage for COVID-19 over-the-counter tests at no cost ends on Thursday, May 11.
However, if you are enrolled in Medicare Part B, you will continue to have coverage with no out-of-pocket costs for appropriate laboratory-based COVID-19 PCR and antigen tests, when a physician or other healthcare professional orders them (such as drive-through PCR and antigen testing or testing in a physician or other healthcare professional’s office).
If you are enrolled in a Medicare Advantage plan, you may have more access to tests depending on your benefits. Check with your plan.
What does this mean for people with Medicaid or Children’s Health Insurance Program?
If you have coverage through Medicaid or the Children’s Health Insurance Program, you will have access to COVID-19 over-the-counter and laboratory testing through Monday, September 30, 2024. After that date, coverage of testing may vary by state.
What does this mean for people with private insurance?
If you have private insurance, coverage will vary depending on your health plan. However, private plans won’t be required by federal law to cover over-the counter and laboratory-based COVID-19 tests after Thursday, May 11.
If your insurance chooses to cover COVID-19 testing, they may require cost sharing, prior authorization, or other forms of medical management.