While New Guidance Requires Most Insurance Companies to Cover Rapid Tests, Lawmakers Want to Ensure Medicare, TRICARE Beneficiaries Can Also Get Reimbursed for Rapid Tests
WASHINGTON, DC—U.S. Senator Sherrod Brown (D-OH) joined his colleagues in two letters to the Biden Administration urging them to extend their guidance requiring insurance companies to pay for rapid tests to include Medicare and TRICARE. Currently, most private insurance companies are required to cover the cost of up to eight over-the-counter at-home COVID-19 tests per person, per month, but the 61 million Americans enrolled in original Medicare or private Medicare Advantage plans do not get this reimbursement, nor do the 9.6 million servicemembers or their families who rely on TRICARE coverage.
Last week, Senator Brown joined Senator Kirsten Gillibrand (D-NY) and seven of their Senate colleagues in a letter to Secretary of Defense Lloyd J. Austin, urging the Department of Defense (DoD) to expand TRICARE coverage to include at-home tests under the same requirements as the Biden Administration is requiring for those covered under private insurance.
“It is critical that the 9.6 million TRICARE beneficiaries have access to at-home tests to keep them and their communities safe,” wrote the lawmakers in their letter to Secretary Austin. “We urge you to expand TRICARE coverage, under your current authority, so that those who are serving and have served our country receive the same protections as other Americans.”
And today, Senator Brown joined Senator Debbie Stabenow (D-MI) and 17 of their Senate colleagues in a letter to Secretary of Health and Human Services Xavier Becerra and Administrator of the Centers for Medicare & Medicaid Services Chiquita Brooks-LaSure, urging them to expand Medicare coverage of free at-home rapid COVID-19 testing to the more than 61 million Americans, including the more than 2.3 million Ohioans, enrolled in Medicare.
“Seniors and people with disabilities enrolled in Medicare are at the highest risk of severe illness from COVID-19, and people over 65 account for nearly three-quarters of all deaths from the virus. The current policy leaves them on the hook for potentially significant out-of-pocket costs,” said the lawmakers in their letter to Secretary Becerra and Administrator Brooks-LaSure. “We share your commitment to making sure Medicare enrollees receive the highest quality health care, including access to free at-home rapid COVID-19 testing, and look forward to working with you to address this issue.”
Brown and Gillibrand were joined on their letter to Secretary of Defense Lloyd J. Austin by Senators Mazie Hirono (D-HI), Elizabeth Warren (D-MA), Richard Blumenthal (D-CT), Tina Smith (D-MN), Mark Kelly (D-AZ), Cory Booker (D-NJ), and Michael Bennet (D-CO).
The letter to Secretary of Defense Lloyd J. Austin can be found here and below.
Dear Secretary of Defense Lloyd J. Austin III and Deputy Assistant Secretary of Defense Dr. David J. Smith:
Thank you for everything that you have done to protect servicemembers, military retirees, and their families from the pandemic. The ability for all Americans to test for COVID-19 could not be more critical in light of the amplified transmissibility of the Omicron variant that accounts for over 90% of new cases in the United States. Beginning on January 15, 2022, the Biden-Harris Administration will require insurance companies and group health plans to cover eight at-home COVID-19 tests (i.e., over-the-counter-, self-, antigen-, nucleic acid amplification-, at-home-, or point-of-care-test per month and per individual.
Currently, TRICARE beneficiaries can only receive coverage for at-home COVID-19 tests if it’s medically necessary as determined by a TRICARE-authorized provider, meaning they must have an order or referral for the test for it to be covered.
We write to urge the Department of Defense to expand TRICARE coverage to include at-home tests under the same requirements as the Biden Administration is requiring for those covered under private insurance. Under the Families First Coronavirus Response Act (FFCRA; P.L. 116- 127), TRICARE is required to cover COVID testing with no cost-sharing requirements for the duration of the Public Health Emergency. Under law, 10 USC Sec 1079(a)(13), TRICARE is directed to cover “medically necessary services and supplies required in the diagnosis and treatment of illness or injury.” The recent guidance by the Centers for Disease Control and Prevention (CDC) demonstrates that home tests are medically necessary. It states, “self-tests can also be used as one of many risk-reduction measures, along with vaccination, masking, and physical distancing, that protect you and others by reducing the chance of viral transmission.”
It is critical that the 9.6 million TRICARE beneficiaries have access to at-home tests to keep them and their communities safe. We urge you to expand TRICARE coverage, under your current authority, so that those who are serving and have served our country receive the same protections as other Americans. With the rapid rise in COVID-19 cases due to the surge of the Omicron variant, it is imperative that this change is made immediately. Thank you for your consideration.
Sincerely,
Brown and Stabenow were joined on the letter to Secretary Becerra and Administrator Brooks-LaSure by Senators Michael Bennet (D-CO), Richard Blumenthal (D-CT), Bob Casey (D-PA), Ben Cardin (D-MD), Tammy Duckworth (D-IL), Kirsten Gillibrand (D-NY), Maggie Hassan (D-NH), Chris Van Hollen (D-MD), Angus King (ME), Amy Klobuchar (D-MN), Bob Menendez (D-NJ), Jack Reed (D-RI), Bernie Sanders (I-VT), Tina Smith (D-MN), Mark Warner (D-VA), Elizabeth Warren (D-MA), and Sheldon Whitehouse (D-RI).
The letter to Secretary Becerra and Administrator Brooks-LaSure can be found here and below.
Dear Secretary Becerra and Administrator Brooks-LaSure:
Thank you for all your work to increase access to free COVID-19 tests around the country, including your recent guidance requiring most insurance companies to cover the cost of up to eight over-the-counter at-home tests per person per month. We strongly encourage you to extend coverage to Medicare, ensuring access for the 61 million Americans enrolled in the program.
Along with vaccination, the widespread availability of free tests will help us defeat this pandemic. That is why we strongly support the Administration’s work over the past year to increase the testing supply and lower costs. A year ago, there were no at-home rapid tests on the market. Today, there are hundreds of millions being distributed around the US, including the Administration’s purchase of 500 million tests with funding included in the American Rescue Plan, and the planned purchase of 500 million more.
Required coverage of testing ordered by a physician, expansion of free testing sites through pharmacies and community health centers, and free at-home rapid tests available through COVIDTests.gov or 1-800-232-0233 are big steps forward, including for seniors. Recent CMS guidance requiring coverage of eight over-the-counter at-home tests per person per month will significantly expand access to millions of Americans with commercial health insurance. However, those enrolled in original Medicare and private Medicare Advantage plans do not have this same access. Seniors and people with disabilities enrolled in Medicare are at the highest risk of severe illness from COVID-19, and people over 65 account for nearly three-quarters of all deaths from the virus. The current policy leaves them on the hook for potentially significant out-of-pocket costs.
We share your commitment to making sure Medicare enrollees receive the highest quality health care, including access to free at-home rapid COVID-19 testing, and look forward to working with you to address this issue.
Sincerely,