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How to get insurance to pay for at-home COVID tests, according to the White House

By: Jonathan Franklin | NPR
Posted on: Tuesday, January 11, 2022

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WASHINGTON, D.C. (NPR) — The Biden administration announced Monday new details on how Americans can get free COVID-19 tests — or get reimbursements from their private insurance. This follows up on an announcement that the White House made last month.

Under the new policy announced by the White House, individuals covered by a health insurance plan who purchase an over-the-counter COVID-19 diagnostic test that has been authorized, cleared or approved by the Food and Drug Administration will be able to have those test costs covered by their insurance beginning this Saturday.

Insurance companies and health plans will be required to cover eight free over-the-counter at-home tests per covered individual per month, according to White House officials. For instance, a family of four all on the same plan would be able to get up to 32 of these tests covered by their health plan per month.

“We are requiring insurers and group health plans to make tests free for millions of Americans. This is all part of our overall strategy to ramp-up access to easy-to-use, at-home tests at no cost,” Health and Human Services Secretary Xavier Becerra stated in a news release Monday.

During Monday’s White House news briefing, press secretary Jen Psaki told reporters that the administration will start to have free coronavirus tests “out the door in the coming weeks.”

“The contracts [for testing companies] are structured in a way to require that significant amounts are delivered on an aggressive timeline, the first of which should be arriving early next week,” Psaki said.

“We also expect to have details on the website as well as a hotline later this week,” Psaki added.

The Biden Administration says it is “incentivizing” insurers and group health plans to set up programs that will allow Americans to get the over-the-counter tests (PCR and rapid tests) directly through preferred pharmacies, retailers or other entities with no out-of-pocket costs.

For people whose health care providers have ordered a COVID-19 test, the Biden administration said there will not be a limit on the number of tests that are covered — including at-home tests.

Currently, state Medicaid and Children’s Health Insurance Program (CHIP) programs must cover FDA-authorized at-home COVID-19 tests without cost-sharing.

Americans who are covered by Medicare already have their COVID-19 diagnostic tests, such as PCR and antigen tests, performed by a laboratory “with no beneficiary cost-sharing when the test is ordered by either a physician, non-physician practitioner, pharmacist, or other authorized health care professional,” the Biden administration says.

At this time, those who are on Medicare will not be able to get their at-home COVID-19 tests reimbursed through the program, according to the Centers for Medicaid & Medicare Services. Currently, Medicaid and Children’s Health Insurance Program plans are required to fully cover the cost of at-home tests.

Last year, the Biden administration issued guidance saying that both state Medicaid and CHIP programs must cover all types of FDA-authorized COVID-19 tests without cost-sharing.