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Options for Medicare enrollees trying to afford COVID-19 tests

Juliette Cubanski, KFF Deputy Director, Program on Medicare Policy, joins Yahoo Finance Live to discuss affordable testing for Medicare recipients, Medicare guidelines around the latest experimental Alzheimer's drug, Medicare premium increases, and health care outlook.

Video Transcript

- The Biden administration's new policy requiring private insurers to cover the cost of at home COVID tests starts tomorrow. But what does that mean for Americans with Medicare? Juliette Cubanski, KFF Deputy Director of the Program on Medicare Policy joins us now to discuss as part of our retirement series brought to you by Fidelity Investments.

And Juliette, I want to start with that question. Many Americans age 65 or older are on fixed incomes. And the cost of paying for multiple at home COVID tests out of pocket can add up. What are the options for those on Medicare to get free or affordable testing?

JULIETTE CUBANSKI: Well, there are a few options. As you noted, people with Medicare are not able to get reimbursement directly from Medicare the way that the Biden administration is requiring people with private insurance to get reimbursement from their health insurance companies. But people with Medicare can take advantage of free testing that's available through health centers in their communities, rural health clinics, pharmacies.

Many of them are offering free testing. So there are options. There is also a new federal government website that has just been announced, covidtests.gov. That will be an option for people to request up to four tests that will be mailed to them at no charge. So Medicare beneficiaries do have access to free testing through those options.

- I want to shift gears and talk too about the news regarding the Alzheimer drug. I don't pronounce it correctly, so I'm avoiding pronouncing it. But it'll be allowed, but in limited use? I mean, a lot of us either have someone we love or someone we know, where we're looking for help for treatment for them. So where do we stand on this?

JULIETTE CUBANSKI: Right. So the FDA approved this new drug called Aduhelm in June of 2021. But for months, we've been waiting to know more from Medicare whether it will cover the drug or not. And just this week, Medicare announced a preliminary decision that it will cover this new drug, but only for patients who participate in approved clinical trials.

That is a relatively restrictive coverage criteria. But Medicare's decision was based on the fact that there's really not a lot of evidence yet supporting the value of this drug, suggesting that it really actually does improve clinical outcomes for people with Alzheimer's disease.

So we're now entering a period of a 30 day public comment period. And in April, Medicare will announce its final decision as to whether it will cover this drug under this clinical trial pathway or whether it will change its mind and issue a different decision. So we're kind of in a wait and see mode until the final decision is announced.

- Going back to the COVID testing and reimbursement policy, given the options for those on Medicare to receive COVID tests as you were breaking down for us, you mentioned the White House's new website as one of several other methods outside of reimbursement. But does this provide enough access for those on Medicare? Or what more do you think could potentially be done?

JULIETTE CUBANSKI: Well, access to at home tests is an issue for all of us. It's very difficult pretty much wherever you are, at any age, to find these at home tests. The Biden administration has announced that it's buying 1 billion at home tests. And those will be distributed as quickly as possible. But supply is certainly an issue for all of us right now.

It, I think, is up to Congress, perhaps, to make decisions as to whether Medicare can actually cover the cost of at home tests for people with Medicare. It may also be an option for Medicare beneficiaries who are enrolled in private Medicare Advantage plans to seek reimbursement for at home tests. But that is not a requirement.

So I think right now we're in a bit of a struggle with the supply of at home tests. And once that loosens up, then I think Medicare beneficiaries, as well as the rest of us, will have an easier time getting access to at home tests, particularly for free through local community sites.

- Is there a final issue? Because we pay attention to these headlines as they affect people who are eligible for Medicare, but is there another issue that isn't getting attention that you might want to highlight right now in addition to what we've already discuss?

JULIETTE CUBANSKI: Well, I think one issue, back to this issue of the new Alzheimer's drug that we were talking about, the Medicare Part B premium for 2022 increased by 15%, which was a dramatic increase relative to what it typically is in a given year.

The Medicare officials, when they announced that premium increase, said that a lot of it was due to this high priced Alzheimer's drug and the fact that Medicare needed revenues in order to pay for what they expected would be billions of in additional spending.

Then the manufacturer of that drug cut the price of it in half. And now we've had this coverage decision, which is likely to really limit access to this drug much more than Medicare officials maybe initially thought when they set the premium for this year. So there's now discussion and perhaps some pressure on Medicare officials to revisit the increase in the Part B premium for this year.

It's not clear the timeline for making any changes. But if there was any relief in the Part B premium, I think that would be very welcome for Medicare beneficiaries, who as you noted, many of them live on unlimited incomes. And so any cost relief I think would be welcome.

- We'll leave it there for now, Juliette Cubanski, KFF Deputy Director of the Program on Medicare Policy. Thank you so much for your time this afternoon.