Private insurance companies will be required to pay for up to eight over-the-counter, at-home Covid tests per month, per member, according to a press release by the Centers for Medicare & Medicaid Services.
The coverage kicked in on January 15, 2022.
This is a “massive shift,” says Dr. Panagis Galiatsatos, a pulmonary and critical care medicine specialist at Johns Hopkins Bayview Medical Center, since “the three things that will help end this pandemic are vaccines, tests, and face masks.”
Making the vaccine free removed a major obstacle to accepting it for lots of people: “The vaccine’s biggest barrier has not been economics, it has been misinformation,” he says. The hope is that the new policy will make this true of at-home tests, as well. “It removes a man-made barrier to allow people to make the best, most health conscious decision,” Galiatsatos says.
For Americans trying to save money, this policy will prove especially useful. If the typical cost for a two-pack of tests is $24, it could save Americans almost $200 per month.
Here are four questions about the new policy, answered by health professionals.
No. You will need to contact your insurance company and see at which pharmacy it is offering free tests. Many health insurance providers will post this information online.
It depends. There are two ways insurance companies can offer free at-home tests:
It can offer free tests on the spot at select pharmacies. Once you find out which pharmacies your insurance company prefers, you can go get a test free of charge. It will be similar to the way you pick up prescriptions or any other pharmacy purchases covered by your insurance
It can reimburse you for a test after you’ve bought it
If you choose the reimbursement route, you’ll have to keep the receipt and submit a claim to your insurance company. You might have done this in the past, says Lindsey Dawson, the associate director of HIV policy at the Kaiser Family Foundation.
“If somebody went to an urgent care center and didn’t use their insurance card but later submitted that to an insurance company, that would be an example of a traditional reimbursement some people might have engaged in,” she says.
If your insurance company offers a preferred list of pharmacies where it will cover the price of the test, you can still buy one out of network, but the full cost might not be covered.
Out-of-network coverage will reimburse you up to $12 per test. For some people, that’ll mean full coverage if they’re finding tests at the average cost of $24 for two. For example, CVS Pharmacy is selling a two-pack of at-home tests for $24.
But let’s say the only place you can find a test is on health-care site Roman, which is selling a two-pack of tests for $30, or $15 a test. Your purchase will only be reimbursed up to $24, or $12 a test.
You cannot be retroactively reimbursed for tests bought before January 15, either.
If the insurance company offers no list of retailers where you can get a free test on the spot, it must reimburse you in full.
“This policy can make these tests more affordable, but it hinges on these tests being available, and right now we are still seeing difficulty accessing these tests,” Dawson says. “Many of the very common, popular tests are out of stock.”
Still, if you do find tests, don’t hoard, Galiatsatos says: “Get as much as you need for the week.”
You only get eight tests per month per person covered by your insurance. This means that a family of four is entitled to 32 tests, 8 per person, each month.
Remember, too, that tests expire. For example, the BinaxNOW COVID-19 Ag Card has a shelf life of 12 months, according to the Food & Drug Administration. The RapCov Rapid COVID-19 Test has a shelf life of 8 months.
So buying tests in bulk and planning to use them throughout the year might not be smart.
Starting January 19, 2022, you’ll be able to order a maximum of four at-home Covid tests, free, from COVIDTests.gov.
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