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Nevilledog
(50,666 posts)Tom Rinaldo
(22,911 posts)BigmanPigman
(51,430 posts)"Get more free Covid tests which are supplied via your health insurance". I'm stocking up on those and free masks.
Meowmee
(5,164 posts)underpants
(182,271 posts)The lady gave me 4 K95s.
Meowmee
(5,164 posts)I will ask about tests because we need those more. I have to get some cough drops so maybe tomorrow.
Ms. Toad
(33,915 posts)And Medicare Advantage is not required to cover them, although some do.
So the most vulnerable population is unable to access free tests (aside from 4 per household).
BumRushDaShow
(127,291 posts)Biden-Harris Administration Will Cover Free Over-the-Counter COVID-19 Tests Through Medicare
Feb 03, 2022 | Medicare Part C Medicare Part D Medicare Parts A & B
As part of the Biden-Harris Administrations ongoing efforts to expand Americans access to free testing, people in either Original Medicare or Medicare Advantage will be able to get over-the-counter COVID-19 tests at no cost starting in early spring. Under the new initiative, Medicare beneficiaries will be able to access up to eight over-the-counter COVID-19 tests per month for free. Tests will be available through eligible pharmacies and other participating entities. This policy will apply to COVID-19 over-the-counter tests approved or authorized by the U.S. Food and Drug Administration (FDA).
This is the first time that Medicare has covered an over-the-counter test at no cost to beneficiaries. There are a number of issues that have made it difficult to cover and pay for over-the-counter COVID-19 tests. However, given the importance of expanding access to testing, CMS has identified a pathway that will expand access to free over-the-counter testing for Medicare beneficiaries. This new initiative will enable payment from Medicare directly to participating pharmacies and other participating entities to allow Medicare beneficiaries to pick up tests at no cost. CMS anticipates that this option will be available to people with Medicare in the early spring.
(snip)
Ms. Toad
(33,915 posts)It really should have been resolved immediately, since the medicare population is the most vulnerable.
Pretty much simultaneously with making free tests available by mail, insurance companies were required to cover 8 free tests a month. Instead of making free tests available for mail order, why not reserve those tests for the Medicare population on a per-person basis for up to 8/month until they could make the necessary changes for Medicare? That would have given the Medicare population equivalent coverage to those covered by insurance.
BumRushDaShow
(127,291 posts)(and as a retired fed), nothing can really happen "immediately" when it comes to modifying data systems (that are maintained under contract) and get that system updated so the distribution of tests to Medicare recipients can be trackable (and auditable) for the long term. And "updated" means getting the requirements (which for Medicare can be complex) to the contractor and ensuring the testing of the changes captures unusual situations.
Simply "setting aside tests" will cause issues for dealing with those Medicare recipients who are in "active senior", "assisted living", or "long-term care" ( "nursing home" ) type facilities, where there would need to be some kind of administrative collaboration with those facilities to determine whether they already have sufficient tests available for those residents who are under direct nursing care and determine how to handle the subset of "independent-living" seniors associated which such complexes who could conceivably pick up their own as needed.
This is versus what was done with the "mail order" option, where a database of addresses was already in the USPS data system. However in that latter case, using that ready-made system for "instant" also missed multi-family dwellings (apartment complexes, condos and other types of housing with a single street address but an apartment/unit number), and thus someone like me didn't get my "mail order" tests until a month later due to being in one of those types of town home complexes with a single address.
And should I note the fact that the other significant vulnerable population - POC - are more likely to be in rentals and would have been impacted by that initial issue with the "mail order" system not allowing sign-ups for those in rentals, regardless of whether they were on Medicare or not (and many still lack health insurance so they wouldn't be able to automatically pick up something at a pharmacy)?
I try not to be myopic about what the reality is regarding the U.S. population, am glad that this initiative was put into place regardless, and am hoping we don't get a new variant surge this spring.
Ms. Toad
(33,915 posts)Most people in assisted living or long-term care have someone handling their Medicare already - it's more complicated than ordering tests. They can add ordering 8 tests every two weeks. If they already have the tests that will leave more for those living in places other than senior housing.
POC living in rentals are likely covered either by Medicaid or by insurance, so doing as I sugggested would not have impaired their access - certainly not any more than the way they handled it.
Depriving those of us on Medicare from access to additional free tests for 2 months . . . and counting, could have easily been handled by limiting free tests to those on Medicare, at a rate equivalent to that of the general population.
BumRushDaShow
(127,291 posts)My point is that CMS runs a huge database that must be modified to handle something like this and it's not going to happen instantly. That is something that must occur BEFORE it even gets to the point of someone logging into the system to "handle the account" for the patient.
The only reason why the "mail order" option went so quickly was because USPS focused on mailing to addresses already in their database but the "mail order" system was never set up to send the kits to multiple units destined for a single street address. So whole swaths of people (including myself who is also in the "vulnerable" category), didn't get the tests until a month later at the earliest and I expect many in my complex probably had issues even trying to sign up. I had signed up the day before it officially went "live" and probably ended up "using up the address" for the complex until they fixed that problem.
That depends on the state and there are quite a few who live in states that never did the Medicaid expansion (mostly red states like MS, that has a 39% black population and who joined 11 other states that haven't done it). And in many cases, you have mutli-generational families living in a single household. Hell, we just had a family in a single rental unit lose 12, including 8 children, to a fire here in Philly back in January.
Ms. Toad
(33,915 posts)The database was used to verify the address, and confirm that tests were only issued in response to one requeste per address.
The Medicare bank database can be used the same way. Either the Medicare recipient, or the person managing their medical care, can make a request using their Medicare #. The Medicare number will match, or not (just like the address). If it matches, the tests can be sent to the name and address associated with the Medicare number.
Same mechanism, different database. No modification of the database requred.
There are multiple people living on Medicare at the same address - who received a grand total of 4 tests. Those individuals do not have access to additional tests.
Even if not all of the multi-generational families are on Medicaid or insurance, more of them will have access to tests via insurance than those on Medicare do.
BumRushDaShow
(127,291 posts)"Make a request" to who and how are they tracking those requests?
A "data field".
This isn't the old days of some government grunt going back to a file room and pulling out a folder for a recipient and filling out a form. This stuff is electronically tracked.
The "mechanism" is not the same because one is shipping pre-purchased kits to residents and the other is a literal "health insurance" entity that will be managing and tracking the reimbursement (to healthcare-related retail outlets) for the cost of certain medical products .
The database for the system (contracted to leverage USPS's street address data) that is being used by USPS employees who are also the invisible people actually "assembling" the kits for shipment, is tracking who ordered what and when and if someone had already requested kits, then they couldn't turn around the next day and try to order again - the request would be rejected. In addition, the vendors who are supplying the tests that are being shipped are being reimbursed by the government for the cost of those tests through some other contract.
And in the case of Medicare - per the article that I posted an excerpt from at the top of this sub-thread, it says this -
So what they have to do is add new data fields for what will now be considered a new category of "Medicare-covered medical devices" (because these test kits are not drugs but are medical devices) and assign a NEW code or codes (if there is an expectation that each brand of test is assigned a unique code) to those tests. This is so that when a pharmacy logs in to seek reimbursement from the government for the cost of the tests that were distributed at their branches, they can enter the ASSIGNED code or codes (and these types of reimbursement codes are regularly updated by CMS as needed and made available to pharmacies and other medical providers) for each of those items (and how many) that were given out so they can get their money back.
So for example, they are not going to use the same codes assigned for say, blood sugar test strips (those covered by Medicare) for COVID-19 test kits. The same type of thing has had to happen with regular health insurers where they updated (or are updating) their own databases to include codes for these kits in order to reimburse the pharmacies for the cost of the kits given to their customers.
When you are talking the transfer of money from the government to some entity, this will then need to be linked to specific allowances from pots of funds (probably mostly "BA" a/k/a "Budget Authority" ) that will be set aside and used for reimbursement to the pharmacies/medical providers as they are most likely coming from the appropriated funds that were created from the various CARES Acts and associated supplemental appropriations. Those would be different funds from those used for other reimbursable items.
Hell, I spent over 30 years working for a heath-related federal agency where we had to enter data into these types of tracking systems and whenever some new Congressional mandate happened (through legislation) then here comes the notifications of the new tracking codes that we had to use.
And most critically - the U.S. Constitution says this (that was drilled into every federal employee) -
(snip)
Section 9.
(snip)
No money shall be drawn from the treasury, but in consequence of appropriations made by law; and a regular statement and account of receipts and expenditures of all public money shall be published from time to time.
(snip)
https://www.law.cornell.edu/constitution/articlei
CMS is not somehow exempt from this requirement. And I remember when CMS was called "HCFA" (Healthcare Finance Administration) before they changed to this (now relatively) new "CMS" (Centers for Medicare and Medicaid Services) name under Shrub - https://www.federalregister.gov/agencies/health-care-finance-administration
In a way, the old name was more descriptive as to their function - "Finance" ($$$$$).
Ms. Toad
(33,915 posts)You're hung up on providing them through medicare as a covered service, which was never my suggestion (that's the process which is taking months to develop).
My suggestion was that the unique Medicare database could be used to target a vulnerable population not eligible for free tests through insurance the same way the USPS database is being used: to check eligibilty (i.e.enrolled in Medicare) and prevent duplication.
Medicare receives and rejects claims all the time. These claims would be rejected and the rejection (service not covered - attached to a unique claim number) could be used as proof of eligibility for the test kit distribution. You could also shorten that process by including, on the specially created form they were obviously capable of creating, a consent which would allow the test kit distribution center to verify Medicare enrollment, as opposed to relying on a rejection to determine eligibility.
Since I never suggested making Medicare pay for the tests, your last point is moot. The test kits came from somewhere, so that problem was already solved. CMS is not paying for the test kits - they are being paid for by the same entity which paid for the nearly worthless set of 4 test kits mailed to households without regard to the number of residents.
BumRushDaShow
(127,291 posts)Remember that Medicare IS a federally-run "insurance company" and as such, you are suggesting something outside the scope of their mandated creation that can run afoul of HIPAA and potential violations of it with any tapping of that data if not planned correctly. Your "simple solution" is not what you think it is.
What the government is trying to do in this instance is to bring Medicare (with respect to COVID-19-related medical products) to a state of equivalency to what many of the private insurers are offering - which would be the "up to 8 free tests per month" offer vs the limit of 4 tests that the "mail order" option is set for. If you have that option for people to pick up those tests at a local healthcare provider or pharmacy, you then save costs for shipping month after month over the long term. This would also avoid the issue of appropriations for these tests eventually running out so any "temporary" programs go bye bye but you might still have the underlying issue of a pandemic with a need for coverage for testing (and this would allow for the government to continue to fund it for Medicare recipients under a different appropriation).
Remember that the whole point of this "mail order" thing was because the tests were continually sold out in the stores and the government, as a deep pocket, could do volume orders to get them distributed another way until such point that the supplies were ratcheted up enough to have pharmacies, etc., able to handle the rapid turnover.
And doing this would preclude having some one-off "temporary" initiative by making these products available over the long term should this pandemic continue to fester with mutated variants that might cause some additional severe outbreaks years in the future. I expect once they have something worked out, it could also include coverage of some of the anti-viral pharmaceuticals currently under EUA, should those gain BLAs.
And as to this -
If you believe the tests are "worthless" then why argue about them?
Ms. Toad
(33,915 posts)to prioritize Medicare recipients - the vulnerable population.
I addressed the potential HIPAA violation. Use the Medicare number in the application, with consent to confirm enrollment in Medicare (all it takes is two added fields in the form the government created from scratch in order to utilize the USPS database: Medicare # and consent to confirm enrollment in Part B.) Instead of checking the USPS database, the check is run against the Part B enrollment. Once established as eligible in this manner, the government could continue to ship 8 tests a month until they run out (or a solution that allows Medicare to cover the tests is created).
As to the tests - sent 4 to an address, once every 1.5 - 2 months are essentially worthless. Many households have more than 4 people, so one test per month (or less) is essentially worthless as a tool to prevent infection.
However, doled out to vulnerable people excluded from insurance - on the same basis as those with insurance are able to get them (8/month) - they would not be worthless. They would meet a need that is probably still a month away from being addressed. There is a significant difference in value if you leverage the available tests to serve a much smaller, vulnerable population, than if you try to spread them out over the entire population of the US.
My simple solution - and yes, it is a simple solution - is to create equivalency now, with the tests available, by using a database that is every much as available as the USPS databse to direct them to the vulnerable population which is being forced to wait for months to have the same access insurance companies were mandated to provide almost immediately.
BumRushDaShow
(127,291 posts)has a cost that the government is apparently planning NOT to do forever just due to what will eventually become a lack the funding to support that. I.e., this "mail order" mechanism was not designed for "extended use". It was a "stopgap measure" to tide people over due to the shortages at the pharmacies and because the federal government can command the type of volume to be able to do it. The USPS personnel who are actually being used to assemble, pack and ship the kits, are not going to be doing this the rest of their work careers.
You continue to ignore the need for getting away from short-term "temporary" solutions and looking at long-term solutions that will be beneficial beyond the moment.
And not all of the vulnerable are on Medicare - there are significant numbers who are not yet Medicare-eligible so the current "mail order" limits were not just impacting the Medicare recipients. However the expectation is that supplies will become more available at pharmacies and other healthcare establishments (notably for the insured which will soon include Medicare, where Medicaid/CHIP recipients are already covered) and anyone who is not insured could still go with the "mail order" and/or "community services" route to get them. There are also a number of states and municipalities providing free test kits.
Here is a recent article on the details, the current status, and other plans - https://www.cnet.com/health/at-home-covid-tests-more-free-kits-coming-how-many-insurance-covers/
Ms. Toad
(33,915 posts)I never said anything about this being a long-term program, or about abandoning the plans in progress to make the tests available through Medicare. The point is that the plans have not been put into effect yet - and not date has been announced by which they will be.
My entire focus is on using the stopgap measure more effectively: targeting a smaller identifable and vulnerable population with an existing federal database for verification, rather than in a political stunt of sending less than one test per month per person across the country.
There was a general solution for people with insurance very quickly. Those people were both eligible for the 4 free tests (and soon another 4), plus the 8/month available through insurance. They have no need for the 4 free tests (or at a minimum, far less need than people on Medicare).
As to the free tests avaialble from states & muncipalities, in large part as soon as the insurance solution was announced, those entities stopped making those free tests available to the public, and reserved the for the test-and-stay program through the schools, based on the assumption that the rest of us had access through insurance. So those tests which had been available free were no longer available to those of us on Medicare.
No solution is going to hit every vulnerable population - but the elderly are a long-identified vulnerable population who are, for the most part, in a Federal database which - with their consent - can confirm their identity and mailing address (and those who aren't, are likely still on an insurance plan and don't need the free tests). Rather than doing the equivalent of a T-shirt toss into a crowd, the tests purchased by the government should have been used to target **at least** the known vulnerable groups for which an easy means of verifying eligibility was available.
I'm not opposed to assisting other vulnerable populations, but you have suggested no easy means to target and verify those populations.
BumRushDaShow
(127,291 posts)that they most likely don't have and be able to make it robust and secure enough to pass any audit nor was it probably considered in the scope of whatever contract/agreement that they put in place with USPS (and any subcontractors). The point being getting tests out to as many households as possible was something that needed to be done and quickly.
And the reason was that many of the Medicare recipients (65+) are retired and not in the workforce so they are not exposed to the pathogen as much as others. I.e., per the last census - https://www.bls.gov/emp/tables/civilian-labor-force-participation-rate.htm
25 to 34 | 81.4
35 to 44 | 82.2
45 to 54 | 80.6
55 to 64 | 64.9
65 to 74 | 25.7
So the Medicare eligible having only about 26% in the workforce vs the next sets down with 65% and 80+% participation in the workforce, behooves that testing be made available for them. This is because they are the most likely to get exposed and possibly spread it to the most vulnerable, since there are more of them working with others in those (often unmitigated) environments, and where many of the smaller businesses have had little or no access to the tests for their employees because the large corporations cornered that market.
From the earliest point in time of this pandemic and the response, the oldest demographics have been prioritized to the max to the point where when it came time for the younger demographics to get vaccinated, etc., they figured why bother? And it had gotten so bad that those who were right on the cusp, were pushed further and further down the priority list as others were re-prioritized over them. And they were and still are the very ones who can and have become the super-spreaders, even if they were able to handle a moderate or severe infection better than others, although not all of them have.
At some point the needs of the many must be taken into consideration and not the needs of the few.
Ms. Toad
(33,915 posts)That's why 75% of the deaths from COVID are in people aged 65 or older.
You are aware that many of the individuals who work in nursing homes (1) work in multiple nursing homes and spread COVID from one ot the other and (2) aren't vaccinated, aren't you? You do not have to be working to be exposed to COVID. The people charged with caring for you bring it right to your doorstep.
It's not about prioritizing the elderly - it is about not denying them any meaningful access to free tests going on 3 months now.
The needs of the many were taken into account - people who are insured got 8 free tests almost immediately - each and every month.
People on Medicare are still waiting. We got a fraction of a free test per month, unless we live alone.
Rather than sending more tests to those who got nearly immediate access to twice that quantity - per person, rather than per household, almost immediately, each and every month - use the free tests (which make virtually no difference when spread over the entire population) where they can make a real difference - to those on Medicare who are stll barred from getting free tests going on 3 months.
BumRushDaShow
(127,291 posts)And you just made my EXACT point about WHO needs access to tests and needs to be tested so they DON'T infect the people they are caring for and/or are working around.
Many of them are in the age group directly under the 65+ (I know some who are neighbors of mine - e.g, the 55 - 64) who make up many of the "home health care" ( "private duty" ) workers who are not working in a facility but are taking care of older and/or disabled individuals who are home-bound.
For example, I have a sister who is 58, who has had R.A. for over 25 years, and who had a hip replacement back last October (her 2nd joint replacement after a previous knee replacement). She ended up acquiring a staph infection in the hospital (the hospital sent her a certified letter apologizing for that).
This lead to a 4 month saga of a litany of health workers who came to her home several times a week to change the wound dressing and adjust the portable "wound-vac" unit that she had to have implanted, while helping her to administer what eventually became 2 different 6-week courses of antibiotics (where the first round got rid of one type gram negative bacteria but not another, requiring another course of a different antibiotic).
The home nurses who came to take care of wound were very personable, experienced at what they had to do, and were in their early 60s (I met 2 of them and we were chatting about all kinds of subjects during those encounters).
My sister is in a household of 3 (her youngest daughter who just turned 16 is still home) and she has a husband who is on dialysis 3 x a week and is on the kidney transplant list. He is 63.
So fuck them? You propose leaving that group - workers and vulnerable patients out from "free tests"? That's just silly.
That statement is ridiculous. With this initial rollout, EVERYONE with more than one resident in a household got a "fraction of a free test" - no matter what their health condition, age, work, or insurance status. And people in rentals are "still waiting" too and could not order at all because the early rollout of the system was not accepting multiple requests for a single address (that would have had "apartment numbers" associated).
You also have many who might still be unemployed (or unemployable) due to the pandemic who may have even contracted it, survived, but have long COVID and can't work, and who are not insured because they can't afford COBRA, nor have they had chance to navigate through the ACA.
And you do realize that there are millions of Medicare recipients who either have supplemental insurance (e.g., retired feds can maintain their FEHB plan when they apply for and start receiving Medicare and it's not considered "Medicare Advantage" ) or who opted for some "Advantage" plan.
This is bullshit. I went out and BOUGHT my own tests when I could find them and got nothing "immediately" until after the initiative of "free tests" from insurers was announced and was handed some by my pharmacist. It took a month for me to get the "government tests" because I am in a complex with multiple homes with a single street address. And in order for me to be reimbursed for what I had already purchased earlier, FEP Blue requires that I literally print out a claim form from their website, fill it out, and then snail mail it to their office here in PA to submit it as a claim (with a copy of the receipt of the tests).
When I picked up a script just after the initiative went into effect, only then did my pharmacist actually hand me some tests "courtesy of my insurance company". Meanwhile I was still waiting for the so-called free "instant" tests.
But you do realize that not all insurers are doing that and an insurer is not going to mail me "free tests" every month. No one is "sending tests" unsolicited to people every month. You have to REQUEST them and those who might be on a mail order prescription plan could conceivably get those test kits in the same fashion after requesting them. I can REQUEST some from a pharmacist and show my card and the pharmacist can hand them to me, where they track what is distributed. BCBS is not mailing anything to me.
Again, the entire point of these "free government tests" was because of a lack of SUPPLY for EVERYONE (except those in the big corporations or corporate industries like the sports teams, etc). There were even some medical facilities who couldn't get a hold of enough testing supplies. And the schools - where you had millions of children who were unvaccinated (mainly because a younger set of elementary age only recently got approved under the EUA for the vaccine) where weekly (or some type of periodic testing) couldn't happen again, due to lack of tests.
Your blanket assertion that all Medicare recipients were "barred from free tests" is nonsense.
I'm sorry but the arguments you have made are purely selfish and would do little to mitigate the problem.
BumRushDaShow
(127,291 posts)the pharmacist said - "Here... courtesy of your health insurance company" and she handed me a prepackaged paper bag that contained 4 free (single) COVID test kits. They were all out of masks unfortunately.
Meowmee
(5,164 posts)We finally got our first order last week.
SharonClark
(10,005 posts)Did you just order your first set of tests because you cant order a second set until next week.
underpants
(182,271 posts)I ordered before there was an full announcement on it last time and got them in 10 or 12 days.
ItsjustMe
(11,166 posts)They will not ship them to a business address, both of my addresses are listed as a business, which they are.
Hekate
(90,189 posts)Nictuku
(3,570 posts)I just got my first set a couple weeks ago.
FakeNoose
(32,340 posts)... and I'm not sure when I'll use them. Maybe I don't need them, but glad I have them just in case.
I don't want to order more because they should go to those who really need them. The tests are only good for 6 months.
USALiberal
(10,877 posts)tblue37
(64,979 posts)Ohio Joe
(21,655 posts)niyad
(112,432 posts)I did, however, pick up two more boxes at my library.
StarryNite
(9,363 posts)mnhtnbb
(31,318 posts)Received a confirmation e-mail.
Received the original order some weeks ago.
I have two trips planned--one in April and one at the end of May/early June--and I'm hoping I won't need the tests. But at least I'll have them.
PasadenaTrudy
(3,998 posts)Demsrule86
(68,347 posts)Callalily
(14,885 posts)I was going to do this anyway, but easy just using your link.
ZonkerHarris
(24,155 posts)msfiddlestix
(7,265 posts)I knew about this of course, but I hadn't "gotten 'round" to actually placing placing the order yet.
so thanks again. that'll add to my previous order plus another kit I actually purchased on Amazon, exactly the same test.
By the way, anyone know when these tests "expire". The "sell by" date?
Demovictory9
(32,320 posts)Hekate
(90,189 posts)UTUSN
(70,496 posts)Last edited Sun Mar 13, 2022, 07:26 PM - Edit history (1)
Totally Tunsie
(10,885 posts)and posted about it yesterday here:
https://www.democraticunderground.com/100216466606
UTUSN
(70,496 posts)It's complicated for me: Swab each nostril for 15 seconds, 5 turns inside each, then dunk swab into the liquid 15 seconds, squeeze swab in tube, 3 drops in collector, 15 minutes then see the results (no). Nothing.
Either the swabbing was deficient or not enough stuff squeezed in the liquid or insufficient drops into the collector.