Biden-Harris administration demands insurance companies and group health plans cover cost of home COVID-19 tests, increasing access to free tests

As part of its continued multi-channel efforts to expand Americans’ access to free testing, the Biden-Harris administration is demanding that insurance companies and group health plans cover the cost of COVID-testing. 19 over-the-counter and at home. Thus, people benefiting from private health coverage can obtain them free of charge from January 15. The new coverage requirement means that most consumers with private medical coverage can go online or to a pharmacy or store, purchase a test, and either have it prepaid through their health insurance plan. or get reimbursed for the cost by submitting a request to their plan. This requirement prompts insurers to cover these costs up front and ensures that individuals do not need a prescription from their health care provider to access these tests for free.

As of January 15, 2022, individuals with private health insurance coverage or covered by a group health plan who purchase an over-the-counter COVID-19 diagnostic test licensed, licensed, or approved by the Food and Drug Administration (FDA) of the United States will be able to have these testing costs covered by their plan or insurance. Insurance companies and health plans are required to cover 8 free over-the-counter home tests per covered person per month. This means that a family of four, all on the same plan, could get up to 32 of these tests covered by their health plan per month. There is no limit to the number of tests, including home tests, that are covered if ordered or administered by a health care provider following an individualized clinical assessment, including for those who might need it because of underlying medical conditions.

“Under President Biden’s leadership, we demand from insurers and group health plans to make testing free for millions of Americans. This is all part of our overall strategy to accelerate access to easy-to-use and free home tests, ”said Xavier Becerra, secretary of HHS. “Since taking office, we’ve more than tripled the number of sites where people can get COVID-19 tests for free, and we’re also purchasing half a billion home rapid tests to send free to Americans who have them. need. . By requiring private health plans to cover people’s home testing, we are further expanding the ability of Americans to get tests for free when they need them. “

Purchases of over-the-counter tests will be covered in the commercial market without the need for a prescription from a healthcare provider or individualized clinical assessment, and without any cost-sharing requirements such as deductibles, user fees or coinsurance, prior authorization or other medical management requirements.

As part of this requirement, the administration encourages insurers and group health plans to put in place programs that allow people to obtain over-the-counter tests directly through pharmacies, retailers or others. preferred entities at no additional cost. Insurers and plans would cover the costs up front, eliminating the need for consumers to submit a claim. When plans and insurers offer tests for initial coverage through pharmacies or preferred retailers, they are still required to reimburse for tests purchased by consumers outside that network, at a rate of up to $ 12 per individual test (or the cost of the test, if less than $ 12). For example, if a person has a plan that offers direct coverage through their preferred pharmacy but that person purchases tests through an online retailer instead, the plan is still required to reimburse them up to $ 12 per individual test. Consumers can get more information from their plan on how their plan or insurer will cover over-the-counter testing.

“Testing is of critical importance to help reduce the spread of COVID-19, as well as to quickly diagnose COVID-19 so that it can be treated effectively. Today’s action further removes financial barriers and extends access to COVID-19 testing to millions of people, ”said CMS administrator Chiquita Brooks-LaSure.

State Medicaid and Children’s Medicare (CHIP) programs are currently required to cover FDA-approved COVID-19 home testing without cost sharing. In 2021, the Biden-Harris administration issued guidelines explaining that state Medicaid and Children’s Health Insurance (CHIP) programs must cover all types of COVID-19 tests authorized by the FDA without cost sharing in under the CMS interpretation of the American Rescue Plan Act of 2019 (ARP). Medicare supports COVID-19 diagnostic tests performed by a laboratory, such as PCR and antigen tests, without cost sharing with beneficiaries when the test is ordered by a physician, non-physician practitioner, pharmacist, or other licensed health care professional. People enrolled in a Medicare Advantage plan should check with their plan to see if their plan offers coverage and payment for over-the-counter COVID-19 testing at home.

This effort is in addition to a number of actions the Biden administration is taking to expand access to testing for all Americans. The US Department of Health and Human Services (HHS) provides up to 50 million free home tests to community health centers and Medicare-certified health clinics for distribution at no cost to patients and community members. The program aims to ensure that COVID-19 tests are made available to populations and settings in need of testing. The HHS has also established more than 10,000 free community pharmacy testing sites across the country. To respond to Omicron’s surge, HHS and FEMA are establishing surge testing sites in states nationwide.

For more information, please see these frequently asked questions, https://www.cms.gov/how-to-get-your-at-home-OTC-COVID-19-test-for-free.html.

For more details on the requirements, visit https://www.cms.gov/files/document/faqs-part-51.pdf.


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