Beginning Saturday, January 15, private health insurers must cover up to eight home COVID-19 tests per month for individuals covered on their health insurance plans. The Biden administration announced the change Monday as it tries to make COVID-19 testing more accessible after receiving criticism over its lack of convenient testing options.
As of Saturday, individuals will be able to either use their insurance when buying home testing kits or submit receipts for reimbursement, with a limit of eight per month. A family of three would be able to obtain 24 tests per month, again, either at no cost via insurance or by reimbursement. 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.
Rapid tests and PCR tests ordered or administered by a health provider will continue to be fully covered by insurance as it is currently.
Over-the-counter test purchases will be covered in the commercial market without the need for a health care provider’s order or individualized clinical assessment and without any cost-sharing requirements such as deductibles, co-payments or coinsurance, prior authorization, or other medical management requirements. There was no mention of any assistance for those without health insurance coverage.
The Omicron variant has shown to be enormously more contagious than the delta variant but poses less of a risk of extreme illness or hospitalization, but a large number of infections have caused seemingly endless waits in line for testing.
President Joe Biden was the recipient of harsh criticism at the end of 2021 for a shortage of at-home rapid tests during a time when many Americans traveled to see family and friends, ignoring some warnings from the CDC that a surge of Omicron cases might be what we see after the holiday season was behind us.
“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. “Since we took office, we have more than tripled the number of sites where people can get COVID-19 tests for free, and we’re also purchasing half a billion at-home, rapid tests to send for free to Americans who need them. 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.”
Consumers can find out more information from their health insurance provider about how their plan or insurer will cover over-the-counter tests, according to the HHS news release.
Private insurers can pay for at-home tests upfront at preferred pharmacies and retailers, or reimburse people who buy the test kits elsewhere, the Department of Health and Human Services said in a press release.
Only tests purchased on or after January 15 are required to be reimbursed, though insurance companies can choose to reimburse tests purchased earlier.
Americans on Medicare won’t be eligible for the federal reimbursement plan, though Medicare already covers Covid-19 tests conducted in labs, and Medicaid and Children’s Health Insurance Program plans are already required to fully reimburse the costs of FDA-approved tests.