According to the new policy, which was first reported by the Associated Press, Americans will be able to either purchase home testing kits for free through their insurance or submit receipts for the tests for reimbursement, up to a monthly per-person limit. For example, a family of four could be reimbursed for up to 32 tests per month. PCR tests and rapid tests ordered or administered by a health provider will remain fully covered by insurance with no limit.
President Joe Biden was chastised during the holiday season for a lack of at-home rapid tests as Americans traveled to see family, despite an increase in cases of the more transmissible omicron variant. Now, the administration is working to make COVID-19 home tests more affordable by increasing supply and lowering prices.
Later this month, the federal government will launch a website to begin mailing 500 million COVID-19 at-home tests. The administration is also expanding emergency rapid-testing sites in areas with the highest caseloads.
The insurer-covered testing would significantly reduce costs for many Americans, and the administration hopes that by removing a barrier to more frequent at-home testing, it will help slow the spread of the virus, get kids back to school faster, and allow people to gather safely.
"This is all part of our overall strategy to increase access to simple, at-home tests at no cost," said Health and Human Services Secretary Xavier Becerra in a statement. "By requiring private health plans to cover people's at-home tests, we are expanding Americans' access to free tests when they need them."
Biden announced the federal requirement late last year, and it goes into effect on January 15, but the administration has been tight-lipped about the details of the plan until now.
The administration is attempting to persuade private insurers to cover the tests upfront and without requiring a lengthy reimbursement process. If purchased from an out-of-network retailer, insurance plans that work with pharmacies and retailers to cover the upfront costs of the tests will be required to reimburse only up to $12 per test. Plans that do not take proactive steps to establish a network of pharmacies would be required to cover the full retail price paid by the customer — which could be more than $12 per test.
The two major health insurance industry groups said insurers would comply with the administration's order, but consumers should be aware that it won't be as simple as flipping a switch.
"Health insurance providers will work as quickly as possible to implement this guidance in ways that limit consumer confusion and challenges," America's Health Insurance Plans president Matt Eyles said in a statement. "While there will almost certainly be some hiccups in the beginning, we will work with the administration to quickly address issues as they arise."
The Blue Cross Blue Shield Association responded in a more direct manner. "We are concerned that the policy does not address the country's limited supply of tests and may cause additional consumer friction as insurers set up a program in just four days," said Kim Keck, the group's president, in a statement.
Both organizations have stated their support for provisions in the Biden administration's plan to combat potential price gouging on tests.
Only tests purchased on or after January 15, according to the administration, will be required to be reimbursed. Some insurers may choose to cover the costs of previously purchased at-home tests, but they are not required to do so.
Mina Bressler, a therapist and mother of two in San Mateo, California, was able to purchase rapid test kits online and share some with a parent who works in the service industry and does not have time to "sit at her computer every hour refreshing the Walmart page to see when tests are in stock."
"I gave her some, and her children left for school." "She's only done it once, but there are a million of her," Bressler explained.
"Just as the availability of vaccines shed light on the inequity of what's going on in this pandemic, I believe testing is the new flashlight for that, because who's going online stalking Walmart?" "It's not the county's most vulnerable people," Bressler added.
Americans with Medicare will not be able to get tests reimbursed through the federal insurance plan, but Medicaid and Children's Health Insurance Program plans must cover the full cost of at-home tests. Those who do not have a covered insurance plan can get free tests from a soon-to-be-launched federal website or from some local community centers and pharmacies.