End of PHE signals end of access to free OTC COVID-19 tests under Medicare Part B

May 11, 2023

HPMS published a memo on May 9, 2023 addressing coverage for over-the-counter (OTC) COVID-19 tests for Medicare Advantage (MA) & Medicare-Medicaid (MMPs) health plans.  Typically, Medicare Part B does not cover OTC tests, but with the pandemic, free OTC COVID-19 tests were available to Medicare beneficiaries.  With the end of the Public Health Emergency (PHE) on May 11, 2023, free OTC COVID-19 tests will no longer be available.

However, CMS is encouraging MA (Part C) and MMPs plans to continue coverage of OTC COVID-19 tests as a supplemental benefit.  This can occur if both of the following are met:

  1. The MA plan must have listed the OTC COVID-19 test as a supplemental benefit in their contract year (CY) 2023 bid
  2. “ if the plan describes its Part C OTC benefit in its bid using general categories rather than by listing specific items, such categories must reasonably include OTC COVID-19 tests.”

For CY 2024 and forward, plans can indicate their intent to “cover OTC COVID-19 tests in their Part C OTC benefit by noting this in their Plan Benefit Package submission.”

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