According to the new White House coronavirus testing program, health insurance companies are now required to cover the cost of eight at-home COVID-19 tests per month for their members. But the program leaves the exact reimbursement and coverage processes up to the insurance companies — and perhaps unsurprisingly, thus far the systems for getting test costs covered are sometimes difficult and often confusing.
The White House issued a mandate that insurance companies begin covering testing costs as of Jan. 15. Insurers are required to reimburse members for FDA-authorized tests purchased on or after that date, up to $12 per test. Companies may also choose to set up partnerships with retailers and pharmacies to make the tests available at no cost at checkout, and with no need for reimbursement.
If the insurer doesn’t have a partnership program where you can get upfront coverage at certain retailers, they must reimburse the full price, even if it exceeds $12 per test.
This week, several of the nation’s largest health insurance companies — including Aetna, Cigna, Humana, UnitedHealthcare and others — have begun releasing details on exactly how you can get your at-home tests reimbursed and/or where to purchase the tests if you want them covered upfront, at the point of sale.
Many insurers have not yet publicly released details on their coverage plans. Of the ones that have, Money found that the process is often vague and may require physically mailing (or faxing!) in reimbursement forms and COVID-19 test receipts. In some cases, even the barcodes on the testing-kit package may need to be included.
The core requirement for insurers is that they aren’t allowed “to design their reimbursement process in a way that unduly delays your reimbursement,” according to the Centers for Medicare and Medicaid Services (CMS). But that doesn’t necessarily mean the process is easy.
This program is only for privately insured Americans and is separate from the home-delivery program through COVIDtests.gov — which provides a one-time shipment of four free at-home COVID-19 tests to anyone, regardless of health insurance status.
How to get insurance to cover COVID-19 test costs
Here’s a look at what some of the largest insurers in the country are requiring.
Details on at-home COVID-19 test coverage from Aetna have been trickling out this week. The company has released an FAQ page on the program, which it has been updating frequently.
“In most cases, OTC [over-the-counter] tests will be covered under your pharmacy benefits,” its website states. “Just check your benefits card to find your prescription benefits manager.”
You can find a list of nearby Aetna partner pharmacies using this pharmacy locator tool. Tests purchased through partner pharmacies should be free at checkout (assuming you can find them available). Tests you purchase outside of those partners are eligible for reimbursement. In those cases, Aetna says you will have to submit a reimbursement claim but did not provide details beyond that.
Anthem has recently updated its website with new information on the at-home testing program, but coverage details are still sparse.
“You may have to pay out of pocket at the time of purchase, but keep your receipt to submit a claim online,” its website states.
To do so:
- Log in to your account on anthem.com.
- Go to the “Claims & Payment” section.
- Select “Submit a Claim.”
Anthem has not publicly released a list of partner pharmacies or retailers that offer upfront coverage, and the company did not respond to Money’s request for comment.
If you have health coverage through Cigna, you will need to print and fill out this at-home COVID-19 test reimbursement form.
For now, the only submission instructions are to fax the completed form to 859-410-2422 or physically mail it — along with any receipts — to the address on the back of your health insurance card.
Cigna has not released a list of partner pharmacies or retailers for upfront coverage and didn’t respond to Money’s request for comment.
To receive reimbursement with Humana, the company is requiring you to print and fill out a reimbursement form, save your receipts and UPC numbers (aka barcodes) for the tests and mail them all to the address on the back of your insurance card. If you live in Puerto Rico, you must use a separate reimbursement form (which is in English and Spanish).
To avoid that reimbursement process, you may get upfront coverage at certain partner pharmacies. Humana has a pharmacy finder tool on its website that you can use to find nearby in-network drugstores.
The company did not respond to Money’s request for more information on its partner pharmacies and retailers.
UnitedHealthcare has released detailed information on the new federal program and how it will cover at-home COVID-19 tests for you.
The company is partnering with Walmart Pharmacies, Sam’s Club, Rite Aid and Bartell Drugs to provide free at-home COVID-19 tests to members. You can go to those locations and receive tests at no cost so long as you show them your UnitedHealthcare card with an OptumRx logo on it.
If you purchase at-home tests outside of those four pharmacy retailers, you can get reimbursed by submitting a claim online at myuhc.com or by filling out this reimbursement form and mailing it to the address on the back of your insurance card.
Have you had trouble getting your health insurance company to cover your at-home COVID-19 tests? We want to hear about it. Send an email to [email protected] about your experience.
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