Effective January 15, 2022, the Biden administration requires insurance companies and group health plans to cover the cost of up to 8 at-home COVID-19 test kits for each person covered by the insurance or plan. This means that a family of four covered by the plan can obtain up to 32 tests per month. The rules governing the no-cost provision of COVID-19 tests ordered by a healthcare provider or after an individualized clinical assessment are not affected by this new program.
Insurance companies and plans can comply with the law in one of two ways. First, they can set up a network of preferred pharmacies at which individuals can receive free over-the-counter COVID-19 test kits by providing their insurance card. In addition, the insurance company or plan has to provide covered individuals the option to obtain test kits for free by mail through a preferred provider. If the insurance company sets up such a network of preferred providers for in-store and mail purchase, covered individuals can still purchase test kits from out-of-network providers. In that case, rather than getting the test kits for free, individuals will be reimbursed $12.00 per test kit or the cost of the test, if less.
If the insurance company or plan does not set up such a network of preferred providers, it must reimburse covered individuals for the full amount of the cost of the test kit. Individuals who purchase test kits from out-of-network pharmacies will be required to submit documentation showing the purchase price and the number of test kits purchased. Some plans may also require the UPC code from the test kit box, so it is a good idea to save those. Your insurance company or plan will advise you of its arrangement for your purchase of at-home test kits. Only COVID-19 diagnostic tests that are authorized, cleared, or approved by the U.S. Food and Drug Administration (FDA) will be covered.
Insurance plans are not required to cover the cost of at-home COVID-19 tests if the tests are for employment purposes such as weekly testing required in order to work. Your plan will advise you if it has such an exclusion. State Medicaid and Children’s Health Insurance Program (CHIP) programs are currently required to cover the cost of FDA-authorized at-home COVID-19 tests for enrollees without cost-sharing. At this time, original Medicare doesn’t pay for at-home COVID tests, but are expected to cover them starting in the spring. However, because some Medicare Advantage Plans may currently cover and pay for at-home tests, you should check with your plan.
These rules regarding no cost at-home tests are in effect during the current public health emergency, which will remain in place until it is terminated by the Department of Health and Human Services.