January 13, 2022
Private insurers soon will have to cover the cost of eight at-home coronavirus tests per member per month, the Biden Administration said on Monday, January 10, reports The New York Times.
Americans will be able to get the tests at their health plan’s “preferred” pharmacies and other retailers with no out-of-pocket costs, according to the Department of Health and Human Services. They can also buy the tests elsewhere and file claims for reimbursement, just as they often do for medical care.
“Today’s action further removes financial barriers and expands access to COVID-19 tests for millions of people,” Chiquita Brooks-LaSure, the Biden Administration’s Medicare and Medicaid chief, said in a statement about the new guidelines.
Roughly 150 million Americans, or about 45% of the population, are privately insured—mostly through their employers. Each enrolled dependent of the primary insurance holder counts as a member.
At out-of-network facilities, insurers’ responsibility would be capped at $12 per test, meaning people could be responsible for any additional costs.
But if a health plan does not establish a network of “preferred” retailers where patients can get tests covered upfront, it will be responsible for whatever claims its patients submit for their eight monthly rapid tests, with no limit on the price.
Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms, said the policy could save families hundreds of dollars a month.
“I would love to see a more comprehensive national testing policy where these tests are free for everybody, regardless of insurance status,” she said. “Will it help everybody? No. It is definitely not the ideal way to lower barriers to COVID testing. But it is helpful.”
Rapid at-home tests are typically sold in packs of two, ranging in cost from about $14 to $34. That can be prohibitively expensive, especially when tests are purchased in bulk.
Some local governments in the United States have invested heavily in rapid testing to counter the latest wave of cases. Washington, D.C., which has experienced a substantial surge in virus cases, now allows residents to pick up four free rapid tests daily at libraries across the city.
The new Biden policy will not apply retroactively to at-home tests that Americans already have purchased. Tests ordered or administered by health providers will continue to be covered by insurance without any co-payment or deductible under a law requiring insurers to fully cover tests at doctor’s offices, public sites, and other facilities.
The Administration is working on other efforts to get coronavirus tests to people regardless of their insurance status—including a plan to deliver 500 million free rapid tests to the homes of Americans who order them, starting later this month.
That plan, along with the new rules for insurers announced Monday, is part of a broader effort by the Biden Administration in recent weeks to catch up to skyrocketing demand for rapid tests, as virus cases have exploded around the nation with the arrival of the highly contagious Omicron variant.
Research contact: @nytimes