The Biden administration just announced a new policy that could help increase the affordability of home COVID-19 testing for the millions of Americans with private health insurance. As of January 15, private health insurance plans will have to pay for eight home COVID-19 tests per person per month.
“The new coverage requirement means that most consumers with private health coverage can go online or to a pharmacy or store, buy a test and either have it prepaid by their health plan,” or be reimbursed for the cost by submitting a claim to their plan, ”according to a press release from Medicare and Medicaid Service Centers (CMS) at the US Department of Health and Human Services (HHS). The policy applies to both group health insurance plans provided by employers and plans purchased in the individual market.
The requirement covers all over-the-counter COVID-19 tests that have been cleared, licensed or approved by the United States Food and Drug Administration (FDA), according to the CMS. People won’t need a prescription or prior authorization from their provider to get the rapid tests covered. The per person limit applies to each covered family member. So, for example, a family of five on the same plan could have up to 40 paid COVID-19 tests for each month.
There are two ways to get the tests. The first: you can buy the tests directly from pharmacies or preferred retailers of your insurer at no cost to you. (The policy is put in place to encourage insurers to set up these preferred seller networks, depending on the CMS version.) In this scenario, free means free, with 100% of the price of the test prepaid and no cost sharing charge for the individual. (This means you won’t have to pay a deductible or co-pay first, and you won’t be charged a coinsurance fee later.)
You can also purchase a COVID test at a pharmacy or retailer (including online) outside of your plan’s preferred network, and then submit a claim for reimbursement. Insurers will reimburse you for the cost later, up to a maximum of $ 12 per individual test. So, even if your insurer has set up a network of preferred sellers, it will still have to reimburse people (up to $ 12) for a test purchased elsewhere.
The new policy will affect the majority of Americans, 60% of whom have private health insurance according to preliminary 2021 data from the National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention (CDC). “Today’s action further removes financial barriers and extends access to COVID-19 testing to millions of people,” said CMS administrator Chiquita Brooks-LaSure. Sabrina Corlette, JD, a research professor at the Center on Health Insurance Reforms at Georgetown University, told New York Times that the new policy could help families save hundreds of dollars on COVID-19 testing each month.
While this is an important milestone, the new insurance policy will not solve all of the barriers Americans face when trying to get home COVID testing, such as the limited availability of home testing. . « If the refund is there but there are no tests to buy, » said Lindsey Dawson, policy analyst with the Kaiser Family Foundation. Time, « That does not help an individual consumer ». In fact, it’s possible that the new policy will actually increase demand for home testing and worsen the supply shortage, Dawson explained. (It’s also worth pointing out that there is a problem with accuracy with many tests themselves, given that some rapid antigenic tests are not as good at detecting the omicron variant of the new coronavirus, as SELF reported. )
Outside of policy, there are still gaps in test coverage for millions of Americans without private health insurance. People with public health insurance through the Medicaid program and the Children’s Medicare program can already get FDA-cleared home COVID-19 tests without cost sharing, according to the CMS. But people with Medicare can only get free lab tests through their plan, and only by order from a healthcare provider or pharmacist. (The HHS is also providing up to 50 million home tests for free to Medicare-certified community health centers and rural health clinics, according to the CMS release.)
The policy also leaves out nearly one in 10 Americans who do not have health insurance (9.6% of people of all ages, according to the NCHS). Offering free home tests based on insurance coverage status « is certainly not the ideal way to lower barriers to COVID testing, » as Corlette told the Time. « But it’s useful. »