The administration is trying to incentivize private insurers to cover the tests up-front and without a cumbersome reimbursement process. Insurance plans that work with pharmacies and retailers to cover the up-front costs of the tests will be required to reimburse only up to $12 per test if purchased through an out-of-network retailer. Plans that don’t move proactively to set up a network of pharmacies would have to cover the full retail price that the customer paid — which could be more than $12 per test. Biden announced the federal requirement late last year, and it kicks in on Jan. 15, but the administration had been silent until now on details of the plan. There was no immediate reaction from insurers, or details yet on potential insurer and retailer partnerships ahead of Saturday’s effective date.
The insurer-covered testing would dramatically reduce costs for many Americans, and the administration hopes that by easing a barrier to more regular at-home testing, it can help slow the spread of the virus, get kids back into school more quickly and help people gather safely. Later this month, the federal government will launch a website to begin making 500 million at-home COVID-19 tests available via mail. The administration also is scaling up emergency rapid-testing sites in areas experiencing the greatest surges in cases.
“This is all part of our overall strategy to ramp up access to easy-to-use, at-home tests at no cost,” Health and Human Services Secretary Xavier Becerra said in a statement. “By requiring private health plans to cover people’s at-home tests, we are further expanding Americans’ ability to get tests for free when they need them.” President Joe Biden faced criticism over the holiday season for a shortage of at-home rapid tests as Americans traveled to see family amid the surge in cases from the more transmissible omicron variant. Now the administration is working to make COVID-19 home tests more accessible, both by increasing supply and bringing down costs.
“Just like vaccines becoming available really shone a light on the inequity of what’s going on in this pandemic, I think testing is the new flashlight for that because who’s going online stalking Walmart? It’s not the most vulnerable people in the county,” Bressler added. Americans on Medicare won’t be able to get tests reimbursed through the federal insurance plan, but Medicaid and Children’s Health Insurance Program plans are required to cover the cost of at-home tests fully. Those who are not on a covered insurance plan can receive free tests through the forthcoming federal website or from some local community centers and pharmacies. “I gave her some and her kids went to school. That’s one time and there’s a million of her,” Bressler said.
Mina Bressler, a mother of two and a therapist in San Mateo, California, was able to buy rapid test kits online and shared some with a parent who works in the service industry and doesn’t have time to “sit at her computer every hour refreshing the Walmart page to see when tests are in stock.” Only tests purchased on or after Jan. 15 will be required to be reimbursed, the administration said. Some insurers may choose to cover the costs of at-home tests purchased earlier, but they won’t have to.
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