Private health insurers told to pay for cost of home COVID-19 tests
Reimbursement to cover 8 exams per person each month
WASHINGTON — Starting Saturday, private health insurers will be required to cover up to eight home COVID-19 tests per month for people on their plans. The Biden administration announced the change Monday as it looks to lower costs and make testing for the virus more convenient amid rising frustrations.
Under the new policy, Americans will be able to either purchase home testing kits for free under their insurance or submit receipts for the tests for reimbursement, up to the monthly per-person limit. A family of four, for instance, could be reimbursed for up to 32 tests per month. PCR tests and rapid tests ordered or administered by a health provider will continue to be fully covered by insurance with no limit.
President Joe Biden faced criticism over the holiday season for a shortage of at-home rapid tests as Americans traveled to see family amid the surge in cases from the more transmissible omicron variant. Now the administration is working to make COVID-19 home tests more accessible, both by increasing supply and bringing down costs.
Later this month, the federal government will launch a website to begin making 500 million at-home COVID-19 tests available via mail. The administration also is scaling up emergency rapid-testing sites in areas experiencing the greatest surges in cases.
The insurer-covered testing would dramatically reduce costs for many Americans, and the administration hopes that by easing a barrier to more regular at-home testing, it can help slow the spread of the virus, get kids back into school more quickly and help people gather safely.
“This is all part of our overall strategy to ramp up access to easy-to-use, at-home tests at no cost,” Health and Human Services Secretary Xavier Becerra said in a statement. “By requiring private health plans to cover people’s at-home tests, we are further expanding Americans’ ability to get tests for free when they need them.”
Biden announced the federal requirement late last year, and it kicks in on Jan. 15, but the administration had been silent until now on details of the plan.
The administration is trying to incentivize private insurers to cover the tests up-front and without a cumbersome reimbursement process. Insurance plans that work with pharmacies and retailers to cover the up-front costs of the tests will be required to reimburse only up to $12 per test if purchased through an out-of-network retailer. Plans that don’t move proactively to set up a network of pharmacies would have to cover the full retail price that the customer paid — which could be more than $12 per test.
There was no immediate reaction from insurers, or details yet on potential insurer and retailer partnerships ahead of Saturday’s effective date.
Only tests purchased on or after Jan. 15 will be required to be reimbursed, the administration said. Some insurers may choose to cover the costs of at-home tests purchased earlier, but they won’t have to.
Americans on Medicare won’t be able to get tests reimbursed through the federal insurance plan, but Medicaid and Children’s Health Insurance Program plans are required to cover the cost of at-home tests fully. Those who are not on a covered insurance plan can receive free tests through the forthcoming federal website or from some local community centers and pharmacies.
Meanwhile, in a reaction to the severe hospital staffing shortages and crushing caseloads that the omicron variant is causing, hospitals around the U.S. are increasingly taking the extraordinary step of allowing nurses and other workers infected with the coronavirus to stay on the job if they have mild symptoms or none at all.
California health authorities announced over the weekend that hospital staff members who test positive but are symptom-free can continue working. Some hospitals in Rhode Island and Arizona have likewise told employees they can stay on the job if they have no symptoms or just mild ones.
The highly contagious omicron variant has sent new cases of COVID-19 exploding to over 700,000 a day in the U.S. on average, obliterating the record set a year ago. The number of Americans in the hospital with the virus is running at about 108,000, just short of the peak of 124,000 last January.
Last month, the Center for Disease Control and Prevention said that health care workers who have no symptoms can return to work after seven days with a negative test, but that the isolation time can be cut further if there are staffing shortages.