Insurers Cover At-Home COVID-19 Tests Starting This Week

Man taking COVID test at home
Michael Bihlmayer / Shutterstock.com

Free COVID-19 tests are on the way for many Americans, the U.S. Department of Health and Human Services announced Jan. 10.

Beginning on Jan. 15, people who have private health insurance can obtain at-home COVID-19 diagnostic tests for free. These are over-the-counter kits — such as those sold online, at pharmacies and in stores — that have received approval from the Food and Drug Administration.

Folks who have work-based health insurance and those who have purchased their own coverage, such as through the federal or their state’s insurance exchange, are eligible for free tests.

If your health insurer or plan provides for direct coverage, the test kits will be free at the point of sale. If it does not, you will need to submit a claim to your insurer for reimbursement.

According to an HHS press release:

“Insurance companies and health plans are required to cover 8 free over-the-counter at-home tests per covered individual per month. That means 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.”

There is no limit on the number of COVID-19 tests that must be covered if a health care provider orders such tests after an individualized clinical assessment.

According to HHS, the federal government is incentivizing health insurers and plans to provide a way for policyholders to obtain tests at the point of sale with no out-of-pocket costs. This means:

  • Insurance plans that establish a network of pharmacies or retailers where consumers can get test costs covered at the point of sale will be allowed to limit the per-test reimbursement amount for tests purchased at retailers outside the network. Such plans only have to reimburse policyholders for up to $12 per test obtained outside the network.
  • Insurance plans that do not set up such a network and instead require policyholders to purchase tests and then make a claim for reimbursement must reimburse the full cost of the test.

Consumers should talk to their insurer to find out if it provides direct coverage of over-the-counter COVID-19 tests, HHS says. If your coverage requires you to file for reimbursement, the federal government encourages you to keep your receipt after purchasing your test.

How can you tell if an over-the-counter COVID-19 test is FDA-approved?

It’s important to note that the policy that goes into effect on Jan. 15 applies only to at-home COVID-19 tests that are authorized by the FDA.

Lists of approved COVID-19 antigen diagnostic tests and molecular diagnostic tests are available on the FDA website.

What if you can’t find at-home COVID-19 tests in stores or online?

In addition to the policy that takes effect on Jan. 15, the federal government is purchasing 500 million at-home COVID-19 tests to be distributed for free to any American who wants one starting in January 2022, according to a Q&A. The Q&A continues:

“There will be a website where Americans can request at-home tests for home delivery—for free. More information on this federal program is expected soon.”

Additionally, free testing is available at many community-based testing sites. To find such a site near you, check out the HHS.gov website.

What about people on Medicare?

The new policy that takes effect on Jan. 15 does not necessarily apply to people covered by Medicare, the federal health insurance program that primarily serves seniors.

However, they might be able to obtain free at-home tests in their community. HHS says it “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.”

Some Medicare Advantage plans might cover over-the-counter COVID-19 tests, too. HHS advises that folks with such a plan contact their insurer to find out if it covers them.

People on Medicare also can get free COVID-19 testing in their community.

Medicare fully covers diagnostic tests — including PCR and antigen tests — that are ordered by an authorized health care professional and performed by a laboratory. This means folks on traditional Medicare and Medicare Advantage will have no cost-sharing responsibility for such tests.

And again, free testing is available at many community-based testing sites.

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