A NEW KIND OF MEDI-GAP — With Covid daily case counts three times higher than the country's previous peak last January, the Biden administration has made testing a larger part of its pandemic strategy. The hyped website that offers free tests directly to the door of every American is actually a small part of the administration's plan, limited to just four tests per household. The bigger part of the testing plan includes new guidance that, starting this week, private insurers must cover the costs of eight over-the-counter rapid tests per person every month — another 32 free tests for a family of four. But there's a giant loophole: The at-home tests won't be reimbursed by Medicare, which covers about 64 million people who are either 65 and older or have long-term disabilities. About 42 percent of Medicare beneficiaries are in what's called an Advantage plan — run by private insurers with generally broader coverage that Medicare beneficiaries can buy into — and some of them will be covered. But the Advantage plans aren't required to cover the tests. And if you're one of the 58 percent of Medicare beneficiaries without an Advantage plan? You can get a test through the new website or at a clinic or doctor's office, but you can't get reimbursed for buying the rapid, at-home tests over the counter. These are the Americans who are in the demographic cohort that is most vulnerable to Covid complications. This is the group with the highest Covid risk factors . People 65 and older have made up almost three-quarters of all Covid deaths during the pandemic, according to the CDC. Medicare, including the part with the Advantage plans, is not designed to cover things that people can get over the counter, without a prescription, said Tricia Neuman, a Medicare expert at the Kaiser Family Foundation, who was recently nominated by Biden to serve on Medicare's board of trustees. The rules-heavy program bills enrolled providers like hospitals, doctors, labs and pharmacies directly for expenses. It doesn't reimburse patients the way a flexible spending account or a commercial insurer sometimes does. "There is not a structure in place that is ready made for reimbursement," she said. The Centers for Medicare & Medicaid Services, the agency responsible for running the program, told Nightly that people in the program can get tested for free through their health care provider or one of 20,000 testing sites. Medicare covers Covid tests that are done by a lab. A doctor can order a test, making them free to Medicare patients. Some clinics are also distributing free rapid, at-home tests. CMS is also encouraging Medicare Advantage plans to voluntarily cover the tests. But it can't require the plans to pay for them. It's unclear right now how many of the Advantage plans are planning to reimburse people who buy the at-home tests. Those measures aren't enough, some advocates and lawmakers say. Rep. Anna Eshoo (D-Calif.), chair of the Energy and Commerce Health Subcommittee, urged the Biden administration, in a letter sent Wednesday, to expand the coverage of at-home tests to Medicare beneficiaries. "There is a bigger question about how long it will take to adopt a fix and whether it would require a change of law or whether CMS could do this on its own," Neuman said. No one seems to know the answer to Neuman's question. The agency didn't get back to Nightly about whether it could fix the issue under the Medicare statute, without new legislation. Nor has CMS told AARP how or whether it will address the issue, said Andrew Scholnick, AARP's senior legislative representative in government affairs. Going to a doctor or pharmacy or another site to get a lab-based test that Medicare will pay for is a huge barrier, Scholnick said. A supply of rapid, at-home tests laying around the house would help seniors more easily figure out whether they can gather with friends and relatives or go to a crowded setting. "To say that they shouldn't have the same level of access to at home tests is ridiculous," he said. "This is unfair and bad policy." Welcome to POLITICO Nightly. Reach out with news, tips and ideas at nightly@politico.com. Or contact tonight's author at rrayasam@politico.com, or on Twitter at @RenuRayasam.
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