Private insurers will have to cover the cost of over-the-counter Covid-19 tests starting Saturday under a Biden administration plan that aims to make it more affordable for people to screen for infections and limit the spread of the Omicron variant.
The policy outlined Monday by the administration means that millions of people with private health insurance can expect insurers to reimburse them for up to eight tests a month per covered individual, or that they will be able to purchase them at no cost through their insurance.
Consumers with private insurance will be able to obtain the tests without any cost sharing such as deductibles, coinsurance or copayments, according to the new policy. A family of four, all on the same health plan, would be able to be reimbursed by their insurance for 32 tests a month, for example.
The Biden administration is encouraging insurers and group health plans to set up partnerships with specific retailers and pharmacies so people can get free over-the-counter tests directly, without paying anything upfront or having to submit a claim for reimbursement.
Daily reported Covid-19 cases in the U.S.
Note: For all 50 states and D.C., U.S. territories and cruises. Last updated
Source: Johns Hopkins Center for Systems Science and Engineering
If insurers set up such programs, they would still be required to reimburse people for tests purchased outside of those networks, but the reimbursement rate would be limited to $12 a test. A person would have to pay the difference if they buy a test outside their insurer’s network, such as through an online retailer, and if the test costs more than $12.
Right now, many over-the-counter tests cost around $12 a test, in a two-pack for about $24, but some cost more.
Consumers can find out from their plan or insurer if it provides direct coverage of over-the-counter Covid-19 tests or whether they will need to submit a claim for reimbursement, officials said. The new policy doesn’t apply to Medicare, with its more than 60 million seniors who are generally at higher risk of severe infection because of their age. Medicaid already covers at-home Covid-19 tests that have been authorized by the Food and Drug Administration.
Some insurer groups said Monday that the administration should have done more sooner to make testing available and affordable.
“The lack of a coordinated national testing strategy two years into this public health emergency leaves too many communities without the resources necessary to mitigate this virus,” said Ceci Connolly, president and chief executive of the Alliance of Community Health Plans, which represents nonprofit health plans.
She said the policy released Monday didn’t address big problems facing widespread use of at-home tests, including a lack of availability at pharmacies and retailers, and delays in shipping tests.
Other insurer groups, however, were more supportive of the changes.
“We recognize that the Administration’s guidance takes steps to mitigate the real risks of price gouging, fraud, and abuse,”
president and chief executive officer of America’s Health Insurance Plans, a national association of healthcare coverage providers, said in a statement. “Health insurance providers will work as quickly as possible to implement this guidance in ways that limit consumer confusion and challenges.”
Shortages of at-home tests amid the spread of the Omicron variant have resulted in complaints to the government of some retailers raising prices, as people search for tests they need to return to work and school. Some families have said they spent hundreds of dollars on tests in recent weeks.
Making diagnostic tests more abundant and affordable is critical for curbing the spread of Covid-19 because people who are identified as infected quickly can isolate and help reduce transmission, as well as potentially get treatment, public health leaders say. The virus can lead to asymptomatic or mild infections in which people are unaware they could pass Covid-19 on to others, even among individuals who are vaccinated and have gotten booster shots. People can also be infectious before they develop noticeable symptoms.
Sabrina Corlette, co-director of Georgetown University’s Center on Health Insurance Reforms, said the new insurance requirement will enable more people to get tests.
“This policy will help millions of families afford Covid tests that allow them to be in school, visit family members and live their lives,” she said. “It’s not perfect, and there will be glitches, but the cost of these tests has been a huge barrier for many people, and this policy helps lower that.”
“‘Five hundred million is not really enough given the surge in cases.’”
Dr. Corlette added that consumer education, including making people aware of what they are eligible for and their insurer’s specific process, is going to be critical. The ease of the reimbursement process will also likely come down to individual companies. “Confusion I think is going to be inevitable,” she added.
Currently, insurers have been covering tests that are prescribed, administered, analyzed or in some other way involving a clinician. There isn’t a limit to the number of tests, including at-home tests, that must be covered by insurers when they are ordered or administered by a health provider, officials said.
The new policy falls under 2020 Covid-19 legislation that requires group health plans to provide Covid-19 testing with no cost sharing, administration officials said. The administration is not providing funds to insurers to reimburse them for over-the-counter testing costs.
The administration also is expected to soon introduce a new website where people can request free tests be mailed to them. U.S. officials are seeking to distribute 500 million free at-home tests starting this month.
That could still fall short of the anticipated demand, according to some health-policy analysts.
“Five hundred million is not really enough given the surge in cases,” said Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation.
The Food and Drug Administration recently granted authorization to two large manufacturers to sell their over-the-counter tests in the U.S., and public-health and diagnostic experts anticipate that supply will increase in the coming weeks.
The new coverage requirements are outlined in guidance from the Labor Department and the Department of Health and Human Services’ Centers for Medicare and Medicaid Services.
The administration will hold a call Tuesday with insurers about the requirement, according to a person familiar with the planning.
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