In an effort to expand accessibility to COVID-19 testing, private health insurance companies and group health plans are now required to cover over-the-counter, at-home COVID-19 tests.
FDA-approved diagnostic test purchases on or after Jan. 15 will be covered in the commercial market without the need for a health care provider’s order or clinical assessment, and without any cost-sharing requirements such as deductibles, co-payments or coinsurance, prior authorization, or other medical management requirements, according to a U.S. Department of Health and Human Services release.
Insurance companies and health plans are required to cover eight free tests per covered individual 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.
Some insurers and group health plans have created programs to allow people to get over-the-counter tests directly through preferred pharmacies, retailers or other sources with no out-of-pocket costs. Insurers and plans cover the costs upfront, eliminating the need for consumers to submit a claim for reimbursement.
Insurers and group health plans without a preferred network of pharmacies or retailers to obtain tests without costs are required to fully reimburse over-the-counter purchases.
Insurers and group health plans with a preferred network are required to reimburse purchases from outside preferred networks, at a rate up to $12 per test. For instance, if a person purchased a test online from Amazon, their insurer is still required to reimburse up to $12 per test.
Consumers should keep their receipts for a claim submission and consult their insurance provider for further steps.
WHAT IF I DON’T HAVE INSURANCE?
Every household is now eligible for four free COVID-19 rapid tests, available for ordering through covidtests.gov or by calling 1-800-232-0233 or TTY 1-888-720-7489. Tests will typically ship within 7-12 days through the USPS.
For the uninsured, there are also now more than 20,000 free testing sites throughout the country, with a list available here.