The federal government recently announced two programs that will help people with the cost of at-home COVID-19 test kits. One program allows Americans to request up to four free tests from the federal government. The second allows people to be reimbursed for the cost of over-the-counter COVID tests by their insurers (up to $12 per test).
Free Tests from the Government
The first program is available to everyone, whether or not they have health insurance. As explained in a recent White House press release, “the Biden Administration is purchasing one billion at-home, rapid COVID-19 tests to give to Americans for free. A half-billion tests will be available for order on January 19th and will be mailed directly to American households.” There will also be “a call line to help those unable to access the website to place orders.”
The administration is working with the postal service to deliver the tests: “All orders in the continental United States will be sent through First Class Package Service, with shipments to Alaska, Hawaii, and the U.S. Territories and APO/FPO/DPO addresses sent through Priority Mail.”
The free tests can be ordered at covidtests.gov and “will typically ship within 7-12 days of ordering” according to NBC 5 Chicago. Initially, there will be a limit of “four rapid tests per residential address, no matter the number of occupants.”
OTC Tests Paid by Insurance
The second program was effective January 15 and allows “individuals with private health insurance coverage or covered by a group health plan” to purchase an over-the-counter COVID-19 diagnostic test and “have those test costs covered by their plan or insurance,” according to guidance released by the Biden Administration.
The new rule requires insurance companies and health plans “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.”
For individuals whose health care provider orders the tests due to underlying medical conditions, there is no limit to the number of tests.
Unfortunately, as the New York Times explains, not all insurers are ready for the new program. Because over-the-counter, at-home tests “do not currently have the type of billing codes that insurers use to process claims,” the rollout could be messy, and “it will probably take weeks to fully set up the system the White House envisions.” In the short-term, people may have to pay out of pocket and then file a claim to get reimbursed, just like in the old days. And—yes—they will probably ask their insurance agents for help filing these claims the old-fashioned way.
It is possible that insurance companies will work with one or two preferred pharmacies initially that will not require members to file a claim, and over time they will add others to the list. Carriers do not want to process claims manually any more than consumers want to file them, so they are working quickly to figure this out.
The second problem, as Larry Levitt with the Kaiser Family Foundation points out on Twitter, is that over-the-counter tests are not readily available in most areas.
Starting Saturday, insurers will be required to pay for 8 at-home COVID tests per person each month.— Larry Levitt (@larry_levitt) January 14, 2022
Do not expect to walk into a pharmacy, flash your insurance card, and walk out with a box of tests.
If you can find a test, save the receipt to submit to the insurance company.
Due to the recent surge in COVID cases, at-home tests are difficult to find. For many consumers, availability is a much bigger issue than cost.
What to Tell Your Clients
While most people don’t have a lot of sympathy for either insurance companies or the government, the best advice might be for them to just be patient with both right now. Yes, individuals can request free tests from the government, but we don’t yet know how smoothly that program will work. And yes, they can have their over-the-counter tests paid for by their health plan, but there’s still a supply problem in some areas. Plus, in many cases they will have to pay up front, hang on to the receipts, and then file a claim to get reimbursed. So, while this will undoubtedly be a great benefit for some people, others may decide that it’s more trouble than it’s worth.