Beginning January 15, insurers will be required to cover COVID-19 at-home tests without requiring an order or clinical assessment from a provider.
Co-pays,deductibles, and coinsurance will not be allowed.
“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 upfront by their health plan, or get reimbursed for the cost by submitting a claim to their plan. This requirement incentivizes insurers to cover these costs upfront and ensures individuals do not need an order from their healthcare provider to access these tests for free,” the Department of Health and Human Services (HHS) said in a news release.
Specifically," insurance companies and health plans are required to cover eight free over the counter at-home tests, per covered individual, per month. There is no limit on the number of tests, including at-home tests, that are covered, if ordered or administered by a healthcare provider, following an individualized clinical assessment, including for those who may need them due to underlying medical conditions," HHS said.
State Medicaid and Children’s Health Insurance Program (CHIP) programs are already required to cover FDA-authorized at-home COVID-19 tests without cost-sharing.