Biden-Harris Administration Requires Insurers to Cover OTC COVID-19 Tests
The Biden-Harris Administration announced this week that it is requiring health insurance companies and group health plans to cover the cost of over-the-counter (OTC), at-home COVID-19 tests, enabling individuals with private health insurance coverage to obtain tests for free beginning January 15, 2022. The new coverage requirement will allow beneficiaries to purchase tests online or in a store and have it paid for up front by the health plan or allows individuals to be reimbursed for the cost by submitting a claim to their plan.
Insurance companies and health plans are required to cover eight free OTC at-home tests per covered individual per month. For a family of four all on the same plan, the family would be able to get up to 32 tests covered by their health plan per month. There is no limit on the number of tests, including at-home tests, that are covered if ordered or administered by a health care provider following an individualized clinical assessment.
OTC test purchases will be covered in the commercial market without the need for a health care provider’s order or individualized clinical assessment and without any cost-sharing requirements such as deductibles, co-payments or coinsurance, prior authorization, or other medical management requirements.
As part of the requirement, The Administration is incentivizing insurers and health plans to set up programs that allow people to procure OTC tests directly through preferred pharmacies, retailers, or other entities with no out-of-pocket costs. Insurers and plans would cover the costs upfront, eliminating the need for consumers to submit a reimbursement claim. Even with preferred pharmacies or retailers, insurers and health plans are required to reimburse tests purchased by consumers out of network at a rate of up to $12 per individual test.
State Medicaid and Children’s Health Insurance Program (CHIP) programs are currently required to cover FDA-authorized at-home COVID-19 tests without cost-sharing.
Additional information is available here.