Health Insurers Cover Home COVID-19 Tests
Starting January 15 at-home CIOVID-19 tests will be free of charge. This order was issued last week Biden-Harris Administration Requires Insurance Companies and Group Health Plans to Cover the Cost of At-Home COVID-19 Tests, Increasing Access to Free Tests.
Free At-Home COVID-19 Test available via USPS. On Jan. 18, every home in the United States can order up to four free COVID-19 tests. January 19, Americans will be able to order free at-home rapid COVID tests from the government at COVIDTests.gov.
The federal guidance requires commercial insurers and group health plans (both fully insured and self-insured) to reimburse consumers for the cost of Over-the-Counter (OTC) COVID-19 diagnostic tests, with or without an order or clinical assessment by a healthcare provider.
Types of COVID Tests:
- Antigen tests, which test for an active infection by detecting specific virus proteins. Most at-home tests and “rapid tests” performed by healthcare providers fall in this category.
- Molecular tests, which test for an active infection by amplifying genetic material from the virus. These are considered the “gold standard” for diagnosing COVID, as they are generally more accurate than antigen tests. The most familiar test from this category is the polymerase chain reaction (or PCR) test, which requires lab processing.
- Antibody tests, which are blood tests that determine if the body has had an immune response to the virus. These tests are not used for diagnosing an active infection.
How Will this work with your Insurer?
Consistent with the guidance Insurers will utilize existing member claims submission procedures to provide benefits without cost-share for OTC COVID-19 tests that members purchase, either online or through other retailers. In addition to the member demographic information that is normally filed with member-submitted claims, the members will be required to certify that the test was purchased for personal use and not for employment purposes.
Customers may receive reimbursement for up to 8 COVID-19 OTC tests per covered individual per calendar month without a health care provider prescription or individualized clinical assessment. For a family of four covered individuals, that equates to 32 tests per month.
Members with Empire Blue Cross, for example, will utilize A.I. apps such as Sydney App or online. Separately, Insurers such as UnitedHealthcare will initially offer for at-home COVID-19 tests are Walmart Pharmacy and Rite Aid Pharmacy. When using Walmart or Rite-Aid there will be no up-front cost and you will not have to submit a form for reimbursement. Note, you may be required to go to the pharmacy counter to obtain the test kits at no cost.
Note, only tests that are FDA approved and sold by an authorized reseller are eligible for reimbursement. For updates, go to Approved COVID-19 Home Tests | NC COVID-19 (ncdhhs.gov).
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