February 4, 2023

Insurance coverage for at-home tests, explained

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

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

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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 the at-home COVID-19 tests for free, either by insurance covering costs upfront or by reimbursing patients. Insurance companies and health plans will be required to cover up to eight at-home tests per month.

Tests ordered by a physician, non-physician practitioner, pharmacist, or other authorized health-care professional — including at-home tests — will still be fully covered by health insurance with no limit.

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

Over-the-counter test purchases won’t require a health-care provider order and won’t require deductibles, co-payments, or coinsurance, or other medical management requirements, the Health and Human Services Department said in a statement.

The Biden administration will incentivize health insurance providers to create programs where people can get over-the-counter at-home tests through a list of preferred pharmacies and retailers, with no out-of-pocket costs. This way, insurers would cover any costs upfront and patients would not need to submit reimbursement claims.

Health insurers will still need to reimburse tests people buy that are 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, Biden administration guidance to state Medicaid and Children’s Health Insurance programs required them to cover all FDA-authorized COVID-19 tests without cost sharing.

Medicare pays for COVID-19 tests performed by a laboratory with no cost to the patient when a test is ordered by a health-care provider, the federal government said. The federal government advised people enrolled in a Medicare Advantage plan to check if their plan covers at-home tests. 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 at-home COVID-19 tests via mail. The administration also is scaling up emergency rapid-testing sites in areas enduring the worst surges.

Biden was heavily criticized over the holiday season as people across the country scrambled to find tests before family gatherings, as the omicron variant caused record-setting case numbers.