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Insurers to Pay for At-home COVID Tests

Jan. 11, 2022
The latest move from the Biden-Harris administration requires private insurers to pay for eight COVID-19 tests per person per month.

Starting Saturday, Jan. 15, Americans with private health coverage will be able to get free COVID-19 tests—without an order from their health care provider.

President Joe Biden is requiring private health insurance companies and group health plans to pick up the cost of eight over-the-counter COVID-19 tests per person per month. There is no limit on the number of tests, including at-home tests, that are covered if ordered or administered by a health care provider following an individualized clinical assessment, including for those who may need them due to underlying medical conditions.

As part of this order, tests will be covered without any cost-sharing requirements such as deductibles, co-payments or coinsurance, prior authorization or other medical management requirements.  

“Under President Biden’s leadership, we are requiring insurers and group health plans to make tests free for millions of Americans. This is all part of our overall strategy to ramp-up access to easy-to-use, at-home tests at no cost,” said HHS Secretary Xavier Becerra in a statement. “By requiring private health plans to cover people’s at-home tests, we are further expanding Americans’ ability to get tests for free when they need them.”

The COVID-19 diagnostic test must be authorized, cleared or approved by the U.S. Food and Drug Administration (FDA). Americans can get their COVID-19 tests online, or go to a pharmacy or store, and either have the at-home test paid up front by their health plan or get reimbursed by submitting a claim.

The Biden-Harris administration is incentivizing insurers and group health plans to set up programs that allow consumers to get over-the-counter tests directly through preferred pharmacies, retailers or other entities to eliminate the need for consumers to submit a claim for reimbursement. However, if someone gets a test outside of that network, plans and insurers are still required to reimburse consumers up to $12 per test (or the cost of the test if less than $12).

“Testing is critically important to help reduce the spread of COVID-19, as well as to quickly diagnose COVID-19 so that it can be effectively treated," said CMS Administrator Chiquita Brooks-LaSure in a statement. "Today’s action further removes financial barriers and expands access to COVID-19 tests for millions of people.” 

Consumers can consult their plan or insurer for more information. In 2021, the administration issued guidance that State Medicaid and Children’s Health Insurance Program (CHIP) programs must cover all types of FDA-authorized COVID-19 tests without cost sharing under CMS’s interpretation of the American Rescue Plan Act of 2019 (ARP). Similarly, Medicare pays for COVID-19 diagnostic tests performed by a laboratory with no beneficiary cost sharing when the test is ordered by a  health care professional. Consumers enrolled in a Medicare Advantage plan should check with their plan to see if their plan offers coverage and payment for at-home over-the-counter COVID-19 tests.

This is the latest in a series of actions the Biden administration has taken to improve consumer access to COVID-19 testing, vaccinations and care. On Dec. 21, Biden announced that his administration will purchase a half-billion at-home, rapid tests to be distributed for free to Americans who want them, with initial delivery expected in January 2022. The administration said it will set up a website where Americans can order those tests delivered to their home for free.

Finding at-home COVID-19 tests has been difficult of late, as many have sought tests to determine if their symptoms are, in fact, COVID-19 as well as to ensure safety before gathering with friends or family over the holidays. Similarly, lines have stretched around the block for those seeking a COVID-19 test from a laboratory, with some pop-up testing closing early because of such high demand. The National Guard has been summoned to help assist with testing.

Nearly three years into the global pandemic, some health experts criticize the lack of test supply and testing infrastructure. A contributing factor is that the FDA has only authorized over-the-counter tests to date, and a majority of them have gotten approval in the past couple months, NPR reports

Compounding the testing issue is the omicron variant, which the World Health Organization designated a variant of concern Nov. 26. Since then, it has become the dominant variant in the United States and sent already high case numbers soaring.

With the omicron and delta variants still raging, the U.S. is now averaging more than 500,000 reported new cases of COVID-19 a day, more than at any previous point in the pandemic. And that number is an undercount of actual infections, because those who either don't or can't get a test or those who take an at-home tests aren't being officially recorded. 

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