Insurers Will Have to Cover 8 At-Home Virus Tests Per Month
Private insurers will soon have to cover the cost of eight at-home coronavirus tests per member per month, the Biden administration said Monday.
People 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.
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Roughly 150 million Americans, or about 45 percent of the population, are privately insured, mostly through their employers. Each enrolled dependent of the primary insurance holder counts as a member.
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The new Biden policy will not apply retroactively to at-home tests that Americans have already 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.
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Matt Eyles, president of the health insurer trade group America’s Health Insurance Plans, said in a statement that insurance companies would “work as quickly as possible to implement this guidance.”
“While there will likely be some hiccups in early days, we will work with the administration to swiftly address issues as they arise,” he said.
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The low availability could hinder the rollout of the reimbursement policy, said Lindsey Dawson, a policy analyst at the Kaiser Family Foundation who has researched the availability of rapid tests.
“If reimbursement exists but there aren’t tests to purchase,” she said, “that doesn’t help an individual consumer.”
She added, “The policy could certainly drive demand, and could exacerbate the problem.”
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Some health plans also expressed concern about the potential lack of supply when the policy rolls out in less than a week.
“We are concerned that the policy does not solve for the limited supply of tests in the country and could cause additional consumer friction as insurers stand up a program in just four days’ time,” said Kim Keck, the chief executive of the Blue Cross Blue Shield Association.
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But as the administration faced intensifying criticism, Mr. Biden announced that his administration would offer 500 million free at-home tests for the nation’s 330 million residents, available to order through a website that is supposed to debut this month.
There will also be a hotline that people can call if they do not have access to a computer or prefer to order tests by phone, a White House official said.
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The success of the administration’s efforts to get more tests to Americans could also be complicated by preliminary research suggesting that rapid antigen tests may miss some Omicron infections even when people are carrying high levels of the virus. That has prompted scientists to warn about misinterpreting negative results when they have symptoms or may have been exposed to the virus. Experts have continued to recommend using the tests.