Insurance Coverage for Home Testing, Explained

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As people continue to struggle to find COVID-19 tests, President Joe Biden’s administration has announced that patients can have their health insurance pay for the at-home tests they purchase.

On Monday, the White House announced that starting Jan. 15, anyone who purchases an FDA-approved home COVID-19 test will be able to have insurance covering the cost. the announcement follows previous promises by the Biden administration to improve testing accessibility.

Here’s how it will work:

» READ MORE: Where to get a free COVID-19 test in Philadelphia

The policy allows people with private health coverage to get COVID-19 tests at home free of charge, either through insurance covering the cost up front or by reimbursing patients. Insurance companies and health plans will be required to cover up to eight home tests per month.

Tests ordered by a physician, non-physician practitioner, pharmacist, or other licensed healthcare professional — including home tests — will still be fully covered by Unlimited Medicare.

“This is all part of our overall strategy to accelerate access to easy-to-use, no-cost home testing,” Health and Human Services Secretary Xavier Becerra said in a statement. “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.”

Over-the-counter test purchases will not require an order from a health care provider and will not require deductibles, co-payments or coinsurance, or other medical management requirements, the Department of Health said. health and social services in a press release.

The Biden administration will urge health insurance providers to create programs for people to get over-the-counter home tests through a list of preferred pharmacies and retailers, with no out-of-pocket fees. That way, insurers would cover all costs up front and patients wouldn’t need to submit claims.

Health insurers will still have to reimburse tests people buy outside of these networks, at a rate of up to $12 per individual test, or the cost of the test if it’s less than $12.

Last year, the advice of the Biden administration to state that the Medicaid and Children’s Health Insurance programs required them to cover all FDA-authorized COVID-19 testing without cost sharing.

Medicare pays for COVID-19 tests performed by a lab at no cost to the patient when a test is ordered by a health care provider, the federal government said. The federal government has advised people enrolled in a Medicare Advantage plan to check whether their plan covers home testing. People enrolled in a Medicare Advantage plan should check with their plan to see if it offers coverage and payment for at-home over-the-counter COVID-19 tests.

The policy is part of a push by the Biden administration to distribute more tests and make them easier to find.

Later this month, the federal government will launch a website to roll out 500 million home COVID-19 tests by mail. The administration is also expanding emergency rapid test sites in areas experiencing the worst surges.

Biden came under heavy criticism during the holiday season as people across the country rushed to find tests ahead of family gatherings as the omicron variant caused a record number of cases.

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