The Biden Administration requires insurance companies and group health plans to cover the cost of over-the-counter COVID tests at home, starting January 15. Most consumers with private coverage will be able to go online, to a pharmacy or store, buy a test and have it paid for by their health insurance plan upfront or get reimbursed after submitting a claim. .
Test kits must be FDA cleared and up to eight tests per month per individual are covered. Purchases will not require a doctor’s prescription and are free of any cost-sharing requirements such as deductibles, co-payments or coinsurance, pre-authorization or other medical management requirements.
There is no limit to the number of tests covered if ordered or administered by a healthcare provider following an individualized clinical assessment, including for those who may need them due to medical conditions. underlying medical conditions.
“This is all part of our overall strategy to accelerate access to easy-to-use, no-cost home testing,” HHS Secretary Xavier Becerra said in a statement. “Since we took office, we have more than tripled the number of sites where people can get free COVID-19 tests, and we are also buying half a billion rapid home tests to send free to Americans who have them. need. . By requiring private health plans to cover people’s home testing, we are further expanding the ability of Americans to get free testing when they need it.
Where plans and insurers offer tests for initial coverage through preferred pharmacies or retailers, they are still required to reimburse tests purchased by consumers outside of that network, at a rate of up to $12 per individual test (or the cost of the test, if less than $12). For example, if a person has a plan that offers direct coverage through their favorite pharmacy but that person instead purchases tests through an online retailer, the plan must still reimburse them for up to $12 per individual test.
State Medicaid and Children’s Health Insurance Program (CHIP) are currently required to cover FDA-authorized COVID-19 home testing without cost sharing. In 2021, the Biden administration issued guidelines explaining that the State Medicaid and Children’s Health Insurance Program (CHIP) programs must cover all types of COVID-19 testing authorized by the FDA without cost sharing under the interpretation by CMS of the American Rescue Plan Act of 2019 (ARP). Medicare pays for laboratory-performed COVID-19 diagnostic tests, such as PCR and antigen tests, without cost-sharing with the beneficiary when the test is ordered by a physician, non-physician practitioner, pharmacist, or other healthcare professional. authorized health.
The U.S. Department of Health and Human Services is providing up to 50 million free at-home tests to community health centers and Medicare-certified rural health clinics for free distribution to patients and community members. The program aims to ensure that COVID-19 tests are made available to populations and settings in need of testing.