Health Insurers to Cover Cost of At-Home COVID-19 Tests Starting Jan. 15
Americans with private health insurance will be able to get at-home COVID-19 tests for free starting this Saturday. The White House is requiring insurance companies and group health plans to cover the cost of over-the-counter, at-home COVID-19 tests, starting January 15th.
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 get it paid for up front by their health plan, or get reimbursed for the cost by submitting a claim to their plan.
Beginning 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 authorized, cleared, or approved by the U.S. Food and Drug Administration (FDA) will be able to have those test costs covered by their plan or insurance. Insurance companies and health plans are required to cover 8 free over-the-counter at-home tests per covered individual per month. That means a family of four, all on the same plan, would be able to get up to 32 of these 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, including for those who may need them due to underlying medical conditions.
Packages that include multiple tests will be considered a single test for the purpose of reimbursement under this plan. To know if a test is eligible, check here for a searchable list of approved rapid antigen-based tests and here for molecular-based (PCR) tests.
If you don’t have coverage from private health insurance, you still have some options for free testing. State Medicaid and Children’s Health Insurance Program (CHIP) programs are currently required to cover FDA-authorized at-home tests without cost-sharing. If you don’t have any health insurance at all, you can get a test for free at U.S. Department of Health & Human Services (HHS) health centers, or possibly at other testing centers run by your local states or municipality.
Every home in the U.S. can also order 4 free at-home COVID-19 tests online starting on January 19. The tests will be completely free. There are no shipping costs and you don’t need to enter a credit card number.
“Testing is critically important to help reduce the spread of COVID-19, as well as to quickly diagnose COVID-19 so that it can be effectively treated. Today’s action further removes financial barriers and expands access to COVID-19 tests for millions of people,” said CMS Administrator Chiquita Brooks-LaSure.
How to Get Reimbursed for At-Home Covid Tests
As of Saturday, January 15, you should be able to purchase a kit from a pharmacy, store or online retailer and make a claim with your insurer using the receipt from your purchase.
But tests might not be completely free, especially now with prices higher than usual. Tests will be covered up in full at the insurer’s “preferred” pharmacies. If you can’t buy them there, then insurers are required to pay for $12 per individual test (or $24 per two-pack) at out-of-network locations. That could leave you with some out of pocket costs.
The White House says there are plans to incentivize insurers so that the reimbursement process is automatic at the point of purchase with participating merchants, without having to file a claim. But that’s not an option just yet.