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Over-the-Counter COVID-19 Test Benefits

Beginning 4/4/2022, and through the end of the COVID-19 PHE, Medicare started paying for U.S. FDA-approved, authorized, or cleared OTC COVID-19 tests at no cost to Medicare beneficiaries with Medicare Part B, including those with MA plans. This demonstration was started to help prevent the spread of COVID-19 and to find out if Medicare payment for these tests will help improve access to testing and consequently result in Medicare savings or other program improvements.

Each eligible Medicare Part B patient can obtain up to eight tests per calendar month. Medicare will not pay for more than eight OTC tests in a month, therefore, it is important that you:

  1. Ask the Medicare patient if they already received any OTC COVID-19 tests in that current calendar month and
  2. submit your claim to traditional Medicare as soon as possible.

If a patient receives more than eight tests in a calendar month, they will be subject to an out-of-pocket expense for the extra test(s) unless they have additional health coverage that may pay for them. If they are unsure how many tests they have received, a voluntary Advanced Beneficiary Notice of Non-Coverage may be provided to them before you give them an OTC COVID-19 test.

The ABN is not required, however, it informs the beneficiary how many tests they are eligible for and lets them know about their financial liability if they go over the eight tests per month limit.

You can read more about this demonstration at CMS’ COVID-19 Over-the-Counter Tests web page, or attend an National Government Services Over-the-Counter COVID-19 Test webinar. Visit the events page on our website to view the schedule and register for an upcoming session.

Posted 1/10/2023