How to Get Your Free At-home COVID Test Covered by Insurance
Most Americans with health insurance will be able to access free COVID-19 tests starting Saturday, but insurers are not required to reimburse those who bought the kits before then.
Last month, President Joe Biden announced the measure as part of a plan aimed at curbing the pandemic. This also included the distribution of 500 million at-home COVID-19 tests to be sent out in January, although there are no more details as yet.
On Monday, the Department of Health and Human Services (HHS) said those covered by a health insurance plan who purchase a federally approved over-the-country COVID-19 diagnostic test will have the cost met by their insurers starting from January 15.
The Biden Administration is incentivizing insurers and group health plans to set up programs where people can get hold of the tests directly through preferred pharmacies, retailers or other entities with no out-of-pocket costs.
This would allow insurers and plans to cover the costs upfront, meaning that consumers would not have to submit a claim for reimbursement.
“This is all part of our overall strategy to ramp-up access to easy-to-use, at-home tests at no cost,” said HHS Secretary Xavier Becerra in Monday’s statement.
Here are some of the other details of the scheme:
Who Is Eligible and How Do You Get a Free COVID-19 Test?
From Saturday, most of the estimated 150 million Americans who are privately insured—mostly through their employers—can go online, to a pharmacy or a store to get an at-home COVID-19 diagnostic test authorized by the U.S. Food and Drug Administration (FDA).
HHS announced on Monday the Biden administration is “strongly incentivizing” health plans and insurers to set up a network of locations like pharmacies or retailers, where people can order online or walk in and pick up at-home over-the-counter COVID-19 tests for free.
The test will either be free at the point of sale, if your health plan gives direct coverage, or by reimbursement if you are charged. People are asked to find out from their plan or insurer which option is possible.
Consumers who have to pay for the kits are asked to keep their receipt to submit any claim for reimbursement, whose time frame for payment will depend on the provider.
Those whose plan does not provide a network of locations where free tests are available can be reimbursed the full cost of a test.
However, consumers who obtain tests outside the network of the preferred locations of their providers will have their reimbursement rates capped at $12 per test, or the price of the test if less than that.
Can I Get Reimbursed If I Have Already Bought a Kit?
The plan announced by the Biden administration only compels health insurers and plans to provide the tests bought on, or after, January 15, 2022.
HHS said plans or issuers “may, but are not required by federal law to, provide such coverage for at-home over-the-counter COVID-19 tests purchased before January 15.”
HHS said people should contact their providers to see if they can get reimbursed for kits purchased before this date, adding that some states “may have existing requirements related to coverage of at-home, over-the-counter COVID-19 tests.”
Insurance companies and health plans have to cover eight free over-the-counter, at-home tests per covered individual per month. This means that a family of four on the same plan would be able to get up to 32 of these tests per month.
What If I Am Not Insured or on Medicare?
HHS said up to 50 million free, at-home tests will be provided to community health centers and Medicare-certified health clinics for distribution at no cost to patients and community members.
It also reiterated the Biden administration’s plan to purchase 500 million at-home tests to be given out for free starting this month, but there is no more information about how to order them online.
“More information on this federal program is expected soon,” HHS said.
Medicaid and the Children’s Health Insurance Program (CHIP) already cover at-home tests with no cost-sharing.
Medicare covers COVID-19 testing in a lab when ordered by a medical professional although “at this time original Medicare cannot pay for at-home tests.”
HHS said that those enrolled in Medicare Advantage plans must check with their insurers to see if at-home tests will be paid for.