As part of its ongoing efforts through many channels to expand Americans’ access to free testing, the Biden-Harris administration is requiring insurance companies and group health plans to cover the cost of COVID -19 at home without a prescription. 19 tests, so that people with private health coverage can get them for free starting January 15. The new coverage requirement means most consumers with private health coverage can go online or go to a pharmacy or store, purchase a test and receive payment up front from their health plan, or be reimbursed for the cost submitting a claim to your plan This requirement encourages insurers to cover these costs up front and ensures that people do not need an order from their health care provider to access these tests for free.
Beginning January 15, 2022, individuals with private health insurance coverage or covered by a group health plan who purchase a U.S.-licensed, licensed, or approved over-the-counter covid-19 diagnostic test. . uu. The Food and Drug Administration (FDA) may have those testing costs covered by your plan or insurance. insurance companies and health plans must cover 8 free, non-prescription home tests per covered person per month. That means a family of four, all on the same plan, could get up to 32 of these tests covered by their health plan 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 after an individualized clinical evaluation, including for those who may need them due to underlying medical conditions.
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“Under the leadership of President Biden, we are requiring insurers and group health plans to provide free testing for millions of Americans. This is all part of our overall strategy to increase access to easy-to-use home tests at no cost,” said HHS Secretary Xavier Becerra. “Since we took office, we’ve more than tripled the number of sites where people can get free COVID-19 tests, and we’re also buying half a billion rapid home tests to ship for free to Americans who they need them. . By requiring private health plans to cover people’s home testing, we are further expanding the ability of Americans to get free testing when they need it.”
Over-the-counter test purchases will be covered in the commercial marketplace without the need for a health care provider order or individualized clinical evaluation, and without any cost-sharing requirements, such as deductibles, copays or coinsurance, prior authorization. or other medical management requirements.
As part of the requirement, the administration is encouraging insurers and group health plans to establish programs that allow people to obtain the over-the-counter tests directly through preferred pharmacies, retailers or other entities without out-of-pocket costs. insurers and plans would cover costs up front, eliminating the need for consumers to file a claim for reimbursement. When plans and insurers offer tests for initial coverage through preferred retailers or pharmacies, they must still reimburse tests purchased by consumers outside of that network, at a fee of up to $12 per individual test (or the cost of the test, if less than $12). For example, if a person has a plan that offers direct coverage through their preferred pharmacy but that person purchases tests through an online retailer, the plan must still reimburse them up to $12 per individual test. consumers can get more information from their plan about how their plan or insurer will cover over-the-counter tests.
“Testing is critically important to help reduce the spread of COVID-19, as well as quickly diagnose COVID-19 so it can be treated effectively. Today’s action further removes financial barriers and expands access to COVID-19 testing for millions of people,” said Chiquita Brooks-Lasure, CMS Administrator.
Currently, state Medicaid and Children’s Health Insurance Program (CHIP) programs must cover FDA-authorized home COVID-19 testing without cost sharing. in 2021, the biden-harris administration issued guidance explaining that state medicaid and children’s health insurance program (chip) programs must cover all types of fda-authorized covid-19 tests with no cost-sharing as interpreted of cms of the act of the american rescue plan of 2019 (arp). medicare pays for covid-19 diagnostic tests performed by a laboratory, such as pcr and antigen tests, at no cost share to the beneficiary 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 in-home, over-the-counter COVID-19 tests.
This effort adds to a series of actions the Biden administration is taking to expand access to testing for all Americans. the United States. the department of health and human services (hhs) is providing up to 50 million free at-home tests to community health centers and medicare-certified health clinics for distribution at no cost to patients and community members community. The program aims to ensure that COVID-19 tests are available to the populations and settings that need testing. hhs has also established more than 10,000 free community-based pharmacy testing sites across the country. To respond to the Omicron surge, HHS and FEMA are creating surge test sites in states across the country.
For more information, see this FAQ, https://www.cms.gov/how-to-get-your-at-home-otc-covid-19-test-for-free.html.
For additional details on requirements, visit https://www.cms.gov/files/document/faqs-part-51.pdf.