Insurers must cover 8 home virus tests per month


The Biden administration announced new guidelines as it continues to work to get people tested for coronavirus regardless of their insurance status.

Rapid test for COVID-19 at Miami International Airport in Miami on Tuesday, January 4, 2022. Saul Martinez/The New York Times

WASHINGTON – Private insurers will soon have to cover the cost of eight home coronavirus tests per month per member, the Biden administration said on Monday.

According to the Department of Health and Human Services, people will be able to get tested at their health plan’s “favorite” pharmacies and other retailers at no out-of-pocket cost. They can also buy the test elsewhere and file a claim for reimbursement, as they often do for medical care.

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“Today’s action removes financial constraints and expands access to COVID-19 tests for millions of people,” Chiquita Brooks-Lasur, the Biden administration’s chief of Medicare and Medicaid, 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 nominated dependent of the primary insurance holder counts as a member.

At out-of-network facilities, insurers’ liability will be limited to $12 per test, which means people may be responsible for any additional costs.

But if a health plan doesn’t establish a network of “preferred” retailers where patients can get tested in advance, it will be responsible for all claims its patients submit to its eight monthly rapid tests. There is no price limit.

Sabrina Corlett, 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 everyone, regardless of insurance status,” she said. “Will this help everyone? No, it’s certainly not the ideal way to reduce barriers to COVID testing. But it is helpful.”

Rapid at-home tests are typically sold in packs of two, ranging in price from about $14 to $34. This can be prohibitively expensive, especially when the tests are purchased in bulk.

Other countries have spent more on rapid testing. In the UK, citizens can access the government website to order a free rapid test for home use. Germany invested millions of dollars to build a network of 15,000 rapid testing sites. The United States has instead focused efforts on vaccines to encourage public procurement and their uptake.

Some local governments in the United States have invested heavily in rapid testing to counter the latest wave of cases. Washington, DC, which has experienced a substantial increase in virus cases, now allows residents to take up to four free rapid tests daily at libraries across the city.

The new Biden policy will not retroactively apply to home tests that Americans have already purchased. Tests ordered or administered by health providers will continue to be covered by insurance without payment or deductible under law, which requires insurers to fully cover tests at doctor’s offices, public sites, and other facilities .

The administration is working on other efforts to get people to get coronavirus tests regardless of their insurance status, including a plan to deliver 500 million free rapid tests to Americans’ homes starting later this month.

The plan, along with new rules for insurers announced on Monday, is part of a broader effort by the Biden administration in recent weeks to capture skyrocketing demand for rapid tests, as virus cases across the country come to a halt. There have been explosions. Infectious Omicron ed.

The administration also announced plans to provide millions of free tests for uninsured Americans at health clinics and other sites in unserved communities. And it recently opened federally-run testing sites in hard-hit regions of the country.

Matt Ailes, president of Health Insurance Plans of America, the health insurer trade group, said in a statement that insurance companies “will work as quickly as possible to implement this guidance.”

“There may be some problems in the initial days, but we will work closely with the administration so that if the problem arises, it can be resolved expeditiously,” he said.

Supplies of tests at pharmacies and grocery stores dried up last month as Omicron took off, and manufacturers are rushing to restore shelves, a scramble that prompted some experts to criticize the administration for being caught flat-footed. has done.

Low availability could hinder the rollout of 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 are no trials for purchase,” she said, “it doesn’t help an individual consumer.”

“The policy can certainly spur demand and exacerbate the problem,” he said.

Dawson said prices have begun to climb at some major retailers, such as Walmart. This could mean significant upfront costs for families who have to file claims for reimbursement, she said.

Some health plans also expressed concerns about a potential shortage of supplies when the policy goes into effect in less than a week.

Kim Keck, chief executive of Blue Cross Blue, said: “We are concerned that the policy does not address the limited supply of tests in the country and could create additional consumer friction as insurers put in place a schedule in only four days’ time.” ” Shield Association.

Georgetown researcher Corlett pointed to several other potential problems with the new policy. The guidance is unclear about how insurers should design reimbursement systems to make the process difficult with less user-friendly websites and more hoops to jump. Nor is there a time limit by which reimbursement must take place.

He said the policy would only exist for the duration of the COVID-19 public health emergency.

Dozens of Democratic lawmakers wrote to President Joe Biden on Sunday to press for expanding access to rapid tests, including building enough for every American to take at least one time a week. He also warned that insurance reimbursement can be time-consuming and discourage those who are less affluent from buying the test.

When Biden announced the reimbursement plan in early December, he drew skepticism from some public health experts who wondered why the United States was not buying the tests in bulk and offering them at no cost, as European countries did.

At the time, White House press secretary Jen Psaki shrugged off the idea of ​​a massive program to provide free tests to Americans.

But as the administration faced intense criticism, Biden announced that his administration would offer 500 million free at-home tests for the country’s 330 million residents to order via a website starting this month. is available.

A White House official said 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.

The administration is rushing to sign a series of testing contracts with companies that already have tests in place or with manufacturers; The first two were announced on Friday.

Officials said more agreements would be announced in the coming days. Officials in the Biden administration have said they are watching for proper tests that are already ready to be distributed to retailers such as CVS and Walgreens.

It is unclear how many tests each household will be able to order as part of the program and what brands will be offered through it. The FDA has authorized more than a dozen at-home antigen tests, some of which were announced last year by the federal government under a new accelerated review program.

The success of the administration’s efforts to get more tests for Americans may also be complicated by preliminary research, suggesting that rapid antigen tests may miss some omicron infections, even when people carry high levels of the virus. Have been This has prompted scientists to warn about misinterpreting negative results when they have symptoms or may have been exposed to the virus. Experts continue to recommend using the tests.