February 22, 2022

As most Medicare beneficiaries wait until spring for no-cost at-home COVID-19 tests, Medicare Advantage plans — such as ACHP members Kaiser Permanente, Fallon Health and Point32Health — innovate to cover tests for their beneficiaries.

Some Medicare Advantage Plans Already Cover At-Home COVID-19 Tests

by Nona Tepper and Maya Goldman, Modern Healthcare

While most of Medicare’s 63 million beneficiaries are still waiting for no-cost at-home COVID-19 tests, some Medicare Advantage carriers already cover them.

Medicare Advantage plans often include supplemental benefits that pay for things the traditional fee-for-service Medicare program doesn’t, including over-the-counter health products. And while big players such as Humana, Cigna and CVS Health’s Aetna aren’t yet covering OTC COVID-19 tests, competitors including UnitedHealthcare, Kaiser Permanente and SCAN Health Plan are. Those insurers make tests available either as part of their benefit packages or by reimbursing pharmacies for dispensing kits.

Fallon Health, a regional insurer in Massachusetts, for example, will retroactively cover all COVID-19 tests purchased by its 12,500 Medicare Advantage members after Jan. 5. By paying for the tests, the health plan believes it can keep its older enrollees out of emergency departments, improve patient outcomes and decrease costs.

Fallon Health is ahead of an industry preparing to incorporate over-the-counter COVID-19 tests into their benefits.

“It’s a great case of Medicare Advantage plans being innovative and flexible. When issues pop up with the pandemic or there’s another need for services, they’re able to be flexible with their supplemental benefits.” — Dan Jones, VP of federal affairs at the Alliance of Community Health Plans

Alliance of Community Health Plans members started exploring over-the-counter COVID-19 test coverage after the federal government began requiring commercial insurance plans to pay for them, said Dan Jones, vice president of federal affairs at the trade association for not-for-profit health insurance companies. Customers had flooded Medicare Advantage plans’ phone lines asking why they couldn’t get free tests, which prompted some companies to take action, he said.

Read the Full Article in Modern Healthcare

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