IBC | COVID-19 OTC Reimbursement Update CMS

April 14, 2022

Effective immediately, the Biden‑Harris Administration announced that people with Medicare Part B, including those enrolled in a Medicare Advantage plan, now have access to FDA-approved,  authorized, or cleared over-the-counter COVID-19 tests at no cost.

Independence Blue Cross

Independence Blue Cross Medicare members with Part B can get up to eight tests per calendar month from participating pharmacies and health care providers for the duration of the COVID-19 public health emergency.

Providers and suppliers eligible to participate include certain types of pharmacies and other health care providers who accept Medicare and are able to furnish ambulatory health care services, such as preventive vaccines, COVID‑19 testing, and regular medical visits. A list of eligible pharmacies and other health care providers that have publicly committed to participate in this initiative can be found here.

Medicare Part B members can:

  • Request free over-the-counter tests for home delivery at covidtests.gov. Every home in the U.S. is eligible to order two sets of four at-home COVID-19 tests.
  • Access no-cost COVID-19 tests through health care providers at over 20,000 testing sites nationwide. A list of community-based testing sites can be found here.
  • Utilize lab-based PCR tests and antigen tests performed by a laboratory when the test is ordered by a physician, non-physician practitioner, pharmacist, or other authorized health care professional at no cost through Medicare.
  • Receive one additional lab-performed test without order or cost-sharing during a public health emergency.

To receive an over-the-counter COVID-19 test at any pharmacy or health care provider that participates in this initiative, your client should present their red, white, and blue Medicare card (even if they have a Medicare Advantage or Medicare Part D plan) to the pharmacist or health care provider so they can remit to Medicare.

Additional resources: CMS fact sheet

For more information, contact a Pinnacle Financial Services representative today

1 (800) 772-6881 x7731 | sales@pfsinsurance.com

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