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Insurance Companies & Group Health Plans Required to Cover Cost of At-Home COVID-19 Tests – New York Health Insurance


Beginning on 1/15/22, the federal government will require insurance companies and group health plans to cover the cost of over-the-counter, at-home COVID-19 tests.

UPDATE 01.21.2022 : COVID-19 At-Home Testing Coverage Carrier Guidelines
For your reference, we have prepared COVID-19 At-Home Testing Coverage Carrier Guidelines. Click HERE to view.

Posted 1.11.22: Insurance Companies & Group Health Plans Required to Cover Cost of At-Home COVID-19 Tests
On Monday, January 10, 2022, the U.S. Department of Health and Human Services (HHS) released information regarding the cost of At-Home COVID-19 tests. Beginning on Saturday, January 15, 2022, the federal government will require insurance companies and group health plans to cover the cost of over-the-counter, at-home COVID-19 tests, so people with private health coverage can get them for free.

According to the press release, “the new coverage requirement means that most consumers with private health coverage can go online or to a pharmacy or store, buy a test, and either get it paid for up front by their health plan, or get reimbursed for the cost by submitting a claim to their plan.”

Overview:

  • Effective January 15, 2022.
  • 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.
  • No limit on the number of tests, including at-home tests, that are covered if ordered or administered by a health care provider following an individualized clinical assessment, including for those who may need them due to underlying medical conditions.
  • Incentivizes insurers to cover these costs up front and ensures individuals do not need an order from their health care provider to access these tests for free.
  • Test must be test approved by the U.S. Food and Drug Administration (FDA).
  • Over-the-counter test purchases will be covered in the commercial market without the need for a health care provider’s order or individualized clinical assessment, and without any cost-sharing requirements such as deductibles, co-payments or coinsurance, prior authorization, or other medical management requirements.
  • When plans and insurers make tests available for upfront coverage through preferred pharmacies or retailers, they are still required to reimburse tests purchased by consumers outside of that network, at a rate of up to $12 per individual test (or the cost of the test, if less than $12).
  • State Medicaid and Children’s Health Insurance Program (CHIP) programs are currently required to cover FDA-authorized at-home COVID-19 tests without cost-sharing.

Read FAQs about ACA Implementation Part 51, FFCRA and Coronavirus Aid, Relief, and Economic Security Act Implementation HERE.

Learn how consumers with Medicare or Medicaid can receive their free at-home over-the-counter test HERE.



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