Starting Saturday, insurance companies must cover the cost of over-the-counter, at-home COVID tests for their members, per a Monday announcement by the federal Department of Health and Human Services
Beginning Jan. 15, people covered by private health insurance or group health plans may have the costs of over-the-counter COVID tests paid for by their insurers up front, or be reimbursed for the costs by submitting a claim to their plan.
Insurers will be required to cover 8 tests per coverage member, per month; for example, a household of four would be able to get up to 32 tests covered by their insurance each month.
“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. “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.”
Already, emergency rapid-testing sites are being scaled up in areas across the country where infections are surging. Later this month, the federal government expects to launch a website making 500 million at-home COVID tests available by mail, as part of a federal plan to push back against rising infection rates.
The administration is trying to incentivize private insurers to cover the tests up-front and without a cumbersome reimbursement process. Insurance plans that work with pharmacies and retailers to cover the up-front costs of the tests will be required to reimburse only up to $12 per test if purchased through an out-of-network retailer. Plans that don’t move proactively to set up a network of pharmacies would have to cover the full retail price that the customer paid — which could be more than $12 per test.
Only tests purchased on or after Jan. 15 will be required to be reimbursed, the administration said. Some insurers may choose to cover the costs of at-home tests purchased earlier, but they won’t have to.
Americans on Medicare won’t be able to get tests reimbursed through the federal insurance plan, but Medicaid and Children’s Health Insurance Program plans are required to cover the cost of at-home tests fully. Those who are not on a covered insurance plan can receive free tests through the forthcoming federal website or from some local community centers and pharmacies.
The Associated Press contributed to this report.