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CLIP — HealthPayerIntelligence: At-Home Testing Coverage for Medicare Beneficiaries

ACHP spoke with HealthPayerIntelligence about at-home testing coverage for Medicare beneficiaries.

Top Challenges, Benefits of At-Home Coronavirus Testing Coverage

by Kelsey Waddill, HealthPayerIntelligence

In the first quarter of 2022, payers witnessed significant changes in at-home coronavirus testing coverage with mixed reactions. These changes—and the influence of the coronavirus pandemic on preventive care—present both opportunities and challenges for health plans.

Leaders in the healthcare industry applauded the CMS decision to expand seniors’ access to over-the-counter coronavirus tests.

“We know that testing is critical for slowing the spread of coronavirus and when you are thinking about public health, the government has a very important role to play. So we appreciate that this Administration has continued to see the importance of public health measures by the government and that the private sector then stepped in and does its part,” Ceci Connolly, president and chief executive officer of the Alliance of Community Health Plans (ACHP), told HealthPayerIntelligence.

Providing an avenue for access to over-the-counter coronavirus tests through Medicare could relieve some of the financial pressure on community health plans to fund these tests, Connolly indicated.

ACHP member plans tend to have small margins of one to two percent—or less. While the payers advocate for more testing, particularly for seniors and other at-risk populations, covering this service for free can drain a community health plan’s limited resources.

Thus, Connolly said that many health plans welcomed Medicare coverage for this preventive care service.

Although many payer organizations voiced their support for Medicare coverage of over-the-counter coronavirus testing, certain challenges have persisted, challenges that have been present since the early days of coronavirus testing.

First, supply chain issues have not abated.

When CMS announced that it would require commercial health plans to cover over-the-counter coronavirus tests, the announcement raised a common outcry among payers, who pointed to the lack of at-home tests that were available due to supply chain issues.

The second hurdle that will continue to have an impact despite Medicare coverage of at-home coronavirus testing is price gouging.

“Price gouging and fraud taking place in the context of this pandemic is outrageous,” Connolly said.

Read the Full Article on HealthPayerIntelligence


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