Medicare Updates: Free At-Home COVID Test Kits & Equitable Relief for Missed Enrollment

Two significant changes, announced this week, are important for advocates working with clients eligible for Medicare.

Medicare covers free at-home COVID test kits: The Medicare program announced that Medicare Part B will cover up to eight free at-home COVID test kits per month for Medicare enrollees. No prescription is required. Medicare enrollees, both in Original Medicare and in Medicare Advantage plans, can get the kits from any participating pharmaciesIndividuals enrolled in Medicare should bring their red, white, and blue Medicare card to get their free tests (even if they have a Medicare Advantage Plan or Medicare Part D plan), but the pharmacy may be able to get the information it needs to bill Medicare without the card. Those in Medicare Advantage plans do not have to use their in-network pharmacy. A Fact Sheet on the initiative contains more details.

Note that the eight test per month limit is distinct from the separate federal program that offers every household in the country two orders of four tests each through the website. Medicare enrollees who order tests from the site do not need to count those tests against their Medicare limit.

Equitable Relief is available for people who, from January 1, 2022 onward, missed enrollment because of SSA telephone issues. Because the Social Security Administration (SSA) national 800 number and field offices both had—and continue to have—technical difficulties with their phone and fax systems since the start of the calendar year, Centers for Medicare & Medicaid Services (CMS) is providing equitable relief to anyone who was unable to enroll in Medicare because of problems getting through to SSA.  The equitable relief runs through December 31, 2022, and applies to anyone who could not enroll (or disenroll) in Part B or in premium Part A during a period of enrollment eligibility because of problems with phone or fax communication with SSA. Although this equitable relief will primarily affect people who missed the January 1 - March 31 General Enrollment Period (GEP), it also applies to individuals who missed an Initial Enrollment Period (IEP) that encompasses dates on or after January 1, 2022, as well as individuals who were unable to make changes based on the employment related Special Enrollment Period (SEP).

Individuals seeking equitable relief can contact either the national SSA phone number, 1-800-772-1213, or their local SSA office. Equitable relief will be granted on a case-by-case basis. From a review of the guidance (EM-22020) to SSA offices, it appears that the following requirements will apply:

  • The individual must have been in an enrollment period on or after January 1, 2022. Since everyone eligible for Medicare has an enrollment period from January 1 through March 31, this requirement will be met by anyone missing an enrollment in the January-March timeframe. Advocates should be aware that, because the guidance notes that the technical problems are on-going, it may be possible to seek equitable relief for individuals who miss a deadline after March 31 if they encounter phone or fax problems that make them miss their enrollment window.
  • The individual must assert that they attempted to reach SSA by phone or attempted to fax information and encountered difficulties, e.g., couldn’t get through, call got dropped or cut off, etc., and were unable to timely enroll or disenroll. Although it would be helpful if the individual had notes on dates or number of times they called, it does not appear that SSA will require that kind of specificity if the individual does not have it available. The instructions to SSA staff state: We encourage technicians to be as responsive and flexible as possible when a current or new beneficiary affected by telephonic technical issues contacts us for any missed enrollment opportunity due to being impacted by SSA’s telephonic technical issues. Advocates should encourage individuals who missed a deadline to seek equitable relief even if they cannot recollect details about the calls they made. Note also that, although on-line application processes have been available, the guidance does not require individuals to justify why they did not or could not use on-line enrollment options. It is enough for the individual to have tried phone access and been unsuccessful.

Note that normal rules apply with respect to the effective date of an enrollment. Thus, if an individual obtains equitable relief for a missed GEP enrollment, the first day of coverage will be no earlier than July 1, 2022, which would have been the first day if the individual had timely enrolled. Additional details are available in the guidance.



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