If you are covered by a health insurance plan and you purchase a Food and Drug Administration-approved, over-the-counter COVID-19 diagnostic test your insurance company should cover the cost, according to the White House.
How can policy holders actually make it happpen?
The Centers for Medicare and Medicaid Services said people can go online, to a pharmacy or store to purchase an at-home over-the-counter COVID-19 diagnostic test authorized by the FDA at no cost. Insurance will either reimburse customers or they may be able to pick up the tests free of charge.
“Be sure to keep your receipt if you need to submit a claim to your insurance company for reimbursement,” said the centers. “If your plan has set up a network of preferred providers at which you can obtain a test with no out-of-pocket expense, you can still obtain tests from other retailers outside that network. Insurance companies are required to reimburse you at a rate of up to $12 per individual test (or the cost of the test, if less than $12).”
This reimbursement model is the method the Biden-Harris administration is using to encourage health plans and insurers to set up a network of locations where people can pick up at-home over-the-counter COVID-19 tests for free, rather than going through the process of having to submit claims for reimbursement. If insurance companies and plan providers do not set up such networks, they will be required to reimburse the full cost of the test, even if the test costs more than $12.
Furthermore, “providers are not allowed to design their reimbursement process in a way that unduly delays your reimbursement.”
Insurance companies and health plans will be required to cover eight free over-the-counter at-home tests per covered individual per month.
So, a family of four on the same plan would be able to get up to 32 of these tests covered by their plan.
As of Tuesday, state Medicaid insurance for those with low income and Children's Health Insurance Program programs must also cover FDA-authorized at-home COVID-19 tests without cost-sharing. Medicare, a program for people age 65 and older, typically will not cover the cost of at-home tests.
However, the U.S. Department of Health and Human Services plans to provide up to 50 million free, at-home tests to community health centers and Medicare-certified health clinics for distribution at no cost to patients and community members.
During a Monday White House news briefing, press secretary Jen Psaki told reporters that the administration will start to have free coronavirus tests “out the door in the coming weeks.”
When health care providers order a COVID-19 test for a patient, there will be no limit on the number of tests that are covered, including at-home tests, the U.S. Department of Health and Human Services said. Americans who are covered by Medicare already have their COVID-19 diagnostic tests, such as PCR and antigen tests, performed by a laboratory “with no beneficiary cost-sharing,” according to the administration.
Plans are not required to provide coverage of testing – including an at-home over-the-counter COVID-19 test – that is for employment purposes.
Some states, including Illinois, prohibit employers from requiring an employee to pay for the cost of medical examinations or records that the employer requires for employment. According to Penn Live, Pennsylvania is also among the states with laws “that might require employers to pay for work-related COVID-19 tests.”
COVID-19 cases were up 85 percent week over week as of Jan. 5 and more than 95 percent of those cases were attributed to the highly contagious omicron variant of the virus. With a record number of hospitalizations in the U.S. as of Tuesday, testing is an important tool to prevent further spread.
According to tweets sent out Monday, the Biden-Harris administration is working to increase access to COVID-19 testing, and this update is one part of those efforts. Providing free tests, establishing free testing sites and a website where people can request tests to be delivered are other parts of this initiative.
Psaki said Monday that more details on the website and a hotline should be available later this week.
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