Medicare Covered my COVID-19 Test Kit – $0 copay

Recently I’ve been hearing conflicting stories on whether COVID-19 over-the-counter test kits are covered by Medicare and, if so, what card should members present for billing. (Previously, we could order kits free of charge through the federal government but that has ended.)

And so I went in to my local CVS (my drug plan’s preferred pharmacy) and picked up a kit in the front of the store and proceeded to the checkout with my Medicare Advantage ID card in hand. “To bill your insurance, you need to do that at the pharmacy register. Or, you can purchase at this register and submit the receipt to your insurance company for reimbursement.”

I went back to the pharmacy register and was told, yes, the Medicare Advantage plan would cover the cost.  But when they tried to process the claim the cashier informed me “your Medicare Advantage plan is saying it doesn’t cover this.”

Her colleague came to help and noticed “You are trying to bill Medicare Part D and the COVID-19 test kits are only covered under Medicare Part B.” Turning to me, she asked, “Mr. Alcorn, did you bring your Original Medicare (red, white and blue) ID card with you?”

I had not.

“No problem, we can look that up with the last four digits of your social security number.”  Well, that was news – CVS can bill Part B and even look up the Medicare Part B ID number? Good to know.

The clerk continued to file the claim for the test kit picked off the shelf from the front of the store with my Part B number and it was still being denied. “Ah,” she said “Medicare Part B will cover the test kit but not THIS brand test kit. We have back here in the pharmacy the kits that are covered by Part B. There we go, all set and your copay is $0.”

So, in short:

• Medicare beneficiaries should request the COVID-19 test kit covered by Medicare through the pharmacy. Kits sold elsewhere in the store are not always covered by Medicare.
• Even if you are enrolled in a Medicare Advantage plan, COVID-19 test kits are billed to your Original Medicare Part B. So bring the red, white and blue card with the 11 digit ID.
• And if you happen to not carry that card with you, as was my case, ask the pharmacy if they can look up your Part B ID as my local CVS did for me.

Ref: https://www.cms.gov/newsroom/fact-sheets/medicare-covers-over-counter-covid-19-tests
https://consumer.ftc.gov/consumer-alerts/2022/10/health-insurance-covers-home-covid-19-tests