Insurers must cover 8 home virus tests per month

Insurers must cover 8 home virus tests per month

WASHINGTON — Private insurers will soon have to cover the cost of eight home coronavirus tests per member per month, the Biden administration said Monday.

According to the Department of Health and Human Services, people can get the tests at their health plan’s “preferred pharmacies” and other retailers with no out-of-pocket costs. They can also buy the tests elsewhere and file a claim for reimbursement, as they often do for medical care.

“Today’s action further removes financial barriers and increases access to Covid-19 testing for millions of people,” Chiquita Brooks-LaSure, chief of Medicare and Medicaid for the Biden administration, said in a statement about the new guidelines.

About 150 million Americans, or about 45 percent of the population, are privately insured, mostly through their employers. Anyone registered at the expense of the main policyholder counts as a member.

At off-network facilities, insurers’ liability would be limited to $12 per test, meaning people could be responsible for any additional charges.

But if a health plan doesn’t establish a network of “preferential” retailers where patients can get pre-tests, it will be responsible for all claims its patients make for their eight monthly rapid tests, with no cap on price.

Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms said the policy could save families hundreds of dollars a month.

“I’d like to see a more comprehensive national testing policy where these tests are free to everyone regardless of insurance status,” she said. “Will it help everyone? New. It is certainly not the ideal way to lower the threshold for Covid testing. But it is useful.”

Rapid home tests are usually sold in packs of two, ranging in cost from about $14 to $34. That can be prohibitive, especially when tests are bought in bulk.

Other countries have spent more money on rapid tests. In the UK, citizens can order free rapid tests for home use via a government website. Germany has invested hundreds of millions of dollars to create a network of 15,000 rapid test sites. The United States has instead focused government purchases on vaccines and efforts to encourage their uptake.

Some local governments in the United States have invested heavily in rapid tests to counter the latest wave of cases. Washington, DC, which has seen a significant rise in virus cases, now allows residents to pick up four free rapid tests daily from libraries across the city.

The new Biden policy will not retroactively apply to home tests Americans have already purchased. Tests ordered or performed by healthcare providers will continue to be covered by insurance without any deductible or deductible under a law requiring insurers to fully cover tests in doctors’ offices, public locations, and other facilities.

The government is working on other efforts to get coronavirus tests on people regardless of insurance status, including a plan to deliver 500 million free rapid tests later this month to the homes of Americans who order them.

That plan, along with new rules for insurers announced Monday, is part of a wider effort by the Biden administration in recent weeks to catch up with skyrocketing demand for rapid tests as virus cases explode across the country. with the advent of the highly contagious Omicron variant.

The government also announced plans to make tens of millions of free tests available to uninsured Americans at health clinics and other locations in underserved communities. And it recently opened federally-run testing sites in hard-hit regions of the country.

Matt Eyles, president of the America’s Health Insurance Plans trade group of health insurers, said in a statement that insurance companies “would work as quickly as possible to implement this guideline.”

“While there will likely be some hiccups at the beginning, we will work with the administration to address issues quickly as they arise,” he said.

Stocks of the tests at pharmacies and supermarkets nearly dried up last month as Omicron descended, and manufacturers rush to replenish the shelves, a struggle that has prompted some experts to criticize the administration for being caught flat-footed.

The low availability could hinder the rollout of reimbursement policies, said Lindsey Dawson, a policy analyst with the Kaiser Family Foundation who has researched the availability of rapid tests.

“If reimbursement exists, but there are no tests to buy,” she said, “that doesn’t help an individual consumer.”

She added: “The policy could certainly boost demand and exacerbate the problem.”

Ms Dawson said prices have started to rise at some major retailers, such as Walmart. That could mean significant upfront costs for families who have to file claims for reimbursement, she said.

Some health plans also expressed concern about the potential lack of supply when the policy rolls out in less than a week.

“We are concerned that the policy will not solve the limited supply of testing in the country and could create additional friction for consumers as insurers set up a program in just four days,” said Kim Keck, the CEO of the Blue Cross Blue. Shield Association.

Ms. Corlette, the Georgetown investigator, pointed out several other potential problems with the new policy. The guidance isn’t explicit on how insurers should design reimbursement systems so they can make the process cumbersome, with less user-friendly websites and more hoops to jump through. Nor is there a term within which repayment must be made.

She added that the policy will only exist for the duration of the Covid-19 public health emergency.

Dozens of Democratic lawmakers wrote to President Biden on Sunday to force him to expand access to rapid tests, including producing enough for every American to use at least one a week. They also warned that insurance reimbursement can be time-consuming and discourage those less fortunate from purchasing tests.

When Mr. Biden announced the reimbursement plan in early December, he met with skepticism from some public health experts who questioned why the United States didn’t buy tests in bulk and offer them at little to no cost, as European countries have done.

At the time, White House press secretary Jen Psaki rejected the idea of ​​a comprehensive program to offer Americans free tests.

But as the administration faced mounting criticism, Mr. Biden announced that his administration would offer 500 million free home tests for the country’s 330 million residents, to be ordered through a website to be released this month.

There will also be a hotline that people can call if they don’t have access to a computer or prefer to order tests over the phone, a White House official said.

The administration is rushing to sign a series of test contracts with companies already in possession of tests, or with manufacturers; the first two were announced on Friday.

More agreements will be announced in the coming days, officials said. Biden administration officials have said they are making sure not to conduct appropriate tests that will already be supplied to retailers such as CVS and Walgreens.

It remains unclear how many tests each household will be able to order as part of the program and which brands will be offered as a result. The FDA has approved more than a dozen at-home antigen tests, including some under a new accelerated review program the federal government announced last year.

The success of the government’s efforts to get more testing in Americans may also be complicated by preliminary research that suggests rapid antigen testing can miss some Omicron infections, even when people have high levels of the virus. That has prompted scientists to warn against misinterpreting negative results when they have symptoms or may have been exposed to the virus. Experts have continued to recommend the use of the tests.

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Rachel Meadows

Rachel Meadows

Trending topics news writer who enjoys cooking, walking her dog and travel.

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