Starting Saturday, January 15, Americans with private health coverage will be able to get free COVID-19 tests, without an order from their health care provider.
President Joe Biden is demanding that private health insurance companies and group health plans cover the cost of eight over-the-counter COVID-19 tests per person per month. There is no limit to the number of tests, including home tests, that are covered if ordered or administered by a health care provider following an individualized clinical assessment, including for those who might need it because of underlying medical conditions.
As part of this order, testing will be covered without any cost sharing requirements such as deductibles, copayments or coinsurance, prior authorization, or other medical management requirements.
“Under President Biden’s leadership, we demand that insurers and group health plans make testing free for millions of Americans. This is all part of our overall strategy to accelerate access to easy-to-use and free home testing, ”HHS Secretary Xavier Becerra said in a statement. “By requiring private health plans to cover people’s home tests, we are further expanding the ability of Americans to get tests for free when they need them.”
The COVID-19 diagnostic test must be cleared, licensed, or approved by the United States Food and Drug Administration (FDA).
Americans can get their COVID-19 tests online, or go to a pharmacy or store, and either have their health plan paid for the home test in advance, or be reimbursed by submitting a claim.
The Biden-Harris administration is urging insurers and group health plans to implement programs that allow consumers to obtain over-the-counter tests directly through pharmacies, retailers or other preferred entities to eliminate the need for consumers to submit a refund request. If someone is tested outside of this network, plans and insurers are still required to reimburse consumers up to $ 12 per test (or the cost of the test if it is less than $ 12).
“Testing is of critical importance to help reduce the spread of COVID-19, as well as to quickly diagnose COVID-19 so that it can be treated effectively. Today’s action further removes financial barriers and extends access to COVID-19 testing to millions of people, ”CMS administrator Chiquita Brooks-LaSure said in a statement.
Consumers can consult their plan or insurer for more information. In 2021, the administration issued guidelines explaining that the State Medicaid and Children’s Health Insurance Program (CHIP) programs must cover all types of COVID-19 tests authorized by the FDA without cost sharing under the interpretation of the CMS of the American Rescue Plan Act of 2019 (ARP). Medicare supports COVID-19 diagnostic tests performed by a laboratory, such as PCR and antigen tests, without cost sharing with beneficiaries when the test is ordered by a physician, non-physician practitioner, pharmacist, or other licensed health care professional. People enrolled in a Medicare Advantage plan should check with their plan to see if their plan offers coverage and payment for over-the-counter COVID-19 testing at home.
On December 21, Biden announced that his administration will purchase half a billion home-based rapid tests that will be distributed free to Americans who want them, with an initial delivery slated for January 2022. The administration announced it will create a site Web. where Americans can order these tests delivered free of charge to their homes.