Update on Out of Pocket Costs of COVID-19 Tests: Medicare Recipients Will Soon Be Eligible for Free At-Home COVID-19 Tests
The new year found Americans mired in the peak of yet another SARS-CoV-2 wave, with the preceding holiday season scarred by overstretched health care systems and testing capacity. In response, the Biden administration has increased the accessibility of at-home COVID-19 tests on multiple fronts.
In January 2022, all US households became eligible to request four free rapid COVID-19 tests either via the website, COVIDTests.gov, or by calling 800-232-0233.
At the same time, the government also mandated that private health insurers cover up to eight at-home antigen tests per month, per covered individual, with reimbursement capped at $12 per testing kit (two tests per kit). Out of pocket costs vary between ~$10-25 per kit. Typically, the insurance provider will cover the upfront cost for in-network pharmacies and retroactively reimburse members who buy test kits from out-of-network pharmacies.
Although Medicare was not initially included in the coverage mandate, at the beginning of February the Biden administration announced that Medicare beneficiaries, including Medicare Advantage, would also become eligible for eight free at-home COVID-19 antigen tests per month, beginning in the early spring.
The expanded coverage will include over 60 million Americans, many of whom fall into the higher risk health category.
Medicaid recipients already have full coverage of at-home COVID-19 tests (8 per month).
Should I get tested for COVID-19?
If the global pandemic has taught us anything, it is that flexibility and a willingness to continuously adjust our goalposts are a must. Cue Omicron. As the newest variant with a name reminiscent of a Transformer spreads like wildfire, COVID-19 testing has struggled--and failed--to keep pace. To date, testing has been an important tool for detecting and limiting viral transmission. However, with rates of COVID-19 in the US skyrocketing (recent daily averages have topped over half a million), testing demand is far outstripping supply. As a result, many labs have been triaging COVID-19 tests, giving priority to those who are symptomatic, immunocompromised, or have other health issues. Likewise, pharmacies have had to place limits on the number of home test kits an individual can purchase in order to curtail panic stockpiling.
The scarcity has prompted President Biden to pledge that the government will purchase 1 billion at-home COVID-19 test kits and make them available, free of charge, to every American household. Online ordering will be available beginning January 19th (the beta version of the website rolled out a day early, on January 18th). There is a limit of four free kits per household. At-home test kits can be ordered online through the federal website: covidtests.gov. Orders will typically ship in 7-12 days. It is recommended to order the test kits now--even if you are not currently concerned about a possible COVID-19 exposure or infection--to be prepared if (and when) the need does arise for testing.
There is certainly hope ahead, with the government's free at home-tests rolling out and signs showing that Omicron may peak soon (and then, if it follows the same course it did in South Africa, quickly ebb). Currently, though, given our limited resources, we need to be mindful regarding when to test for COVID-19. A recent controversial piece in The Atlantic suggested that the healthiest and wealthiest Americans, those without symptoms or known exposures, should stop "wasting" COVID-19 tests on social engagements and other non-essential activities. On the other hand, many experts point out that if mildly symptomatic or asymptomatic people are unable to easily secure tests they are likely to continue circulating in the population and increasing the transmission of COVID-19. Mandated testing, such as that required by workplaces, schools, and travel, is a different story as it leaves us little choice in the matter.
As far as a personal decision to obtain testing, the CDC recommends that you should get tested for a current COVD-19 infection if:
1) You have symptoms of COVID (such as cough, fever, difficulty breathing, fatigue, new loss of taste or smell (Symptoms of COVID-19 | CDC) you should be tested right away.
2) You have a known exposure to someone with suspected or confirmed COVID-19. In this case, if you are fully vaccinated (including boosters) you should be tested ~ 5-7 days after the most recent exposure.
If you are not fully vaccinated (including not having received a booster on schedule), you should get tested right away and then, if the test result is negative, get tested again ~ 5-7 days after the last exposure (or immediately if symptoms develop, as above).
If you have been exposed to someone with COVID-19, are asymptomatic, and you have tested positive for COVID-19 within the past 3 months and recovered, you do not need to get tested.
If you are still considering whether or not you need a COVID-19 test, the CDC has an interactive online assessment tool via which you answer a series of questions and you are provided with recommended actions and resources based on your responses (no identifying personal health information is required). https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/coronavirus-self-checker.html#content
* Information contained herein has been updated and is current as of January 19th, 2022.
* CDC statement regarding recommendations: "These recommendations do not apply to health care personnel and do not supersede state, local, tribal, or territorial laws, rules, and regulations."
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