Posted on 01/11/2022 5:22:14 AM PST by Red Badger
As part of its ongoing efforts across many channels to expand Americans’ access to free testing, the Biden-Harris Administration is requiring insurance companies and group health plans to cover the cost of over-the-counter, at-home COVID-19 tests, so people with private health coverage can get them for free starting January 15th. 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 up front 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 up front and ensures individuals do not need an order from their health care provider to access these tests for free.
Beginning January 15, 2022, individuals with private health insurance coverage or covered by a group health plan who purchase an over-the-counter COVID-19 diagnostic test authorized, cleared, or approved by the U.S. Food and Drug Administration (FDA) will be able to have those test costs covered by their plan or insurance. Insurance companies and health plans are required 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. There is no limit on the number of tests, including at-home tests, that are covered if ordered or administered by a health care provider following an individualized clinical assessment, including for those who may need them due to underlying medical conditions.
“Under President Biden’s leadership, we are requiring insurers and group health plans to make tests free for millions of Americans. This is all part of our overall strategy to ramp-up access to easy-to-use, at-home tests at no cost,” said HHS Secretary Xavier Becerra. “Since we took office, we have more than tripled the number of sites where people can get COVID-19 tests for free, and we’re also purchasing half a billion at-home, rapid tests to send for free to Americans who need them. 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.”
Over-the-counter test purchases will be covered in the commercial market without the need for a health care provider’s order or individualized clinical assessment, and without any cost-sharing requirements such as deductibles, co-payments or coinsurance, prior authorization, or other medical management requirements.
As part of the requirement, the Administration is incentivizing insurers and group health plans to set up programs that allow people to get the over-the-counter tests directly through preferred pharmacies, retailers or other entities with no out-of-pocket costs. Insurers and plans would cover the costs upfront, eliminating the need for consumers to submit a claim for reimbursement. When plans and insurers make tests available for upfront coverage through preferred pharmacies or retailers, they are still required to reimburse tests purchased by consumers outside of that network, at a rate of up to $12 per individual test (or the cost of the test, if less than $12). For example, if an individual has a plan that offers direct coverage through their preferred pharmacy but that individual instead purchases tests through an online retailer, the plan is still required to reimburse them up to $12 per individual test. Consumers can find out more information from their plan about how their plan or insurer will cover over-the-counter tests.
“Testing is critically important to help reduce the spread of COVID-19, as well as to quickly diagnose COVID-19 so that it can be effectively treated. Today’s action further removes financial barriers and expands access to COVID-19 tests for millions of people,” said CMS Administrator Chiquita Brooks-LaSure.
State Medicaid and Children’s Health Insurance Program (CHIP) programs are currently required to cover FDA-authorized at-home COVID-19 tests without cost-sharing. In 2021, the Biden-Harris Administration issued guidance explaining that State Medicaid and Children’s Health Insurance Program (CHIP) programs must cover all types of FDA-authorized COVID-19 tests without cost sharing under CMS’s interpretation of the American Rescue Plan Act of 2019 (ARP). Medicare pays for COVID-19 diagnostic tests performed by a laboratory, such as PCR and antigen tests, with no beneficiary cost sharing when the test is ordered by a physician, non-physician practitioner, pharmacist, or other authorized health care professional. People enrolled in a Medicare Advantage plan should check with their plan to see if their plan offers coverage and payment for at-home over-the-counter COVID-19 tests.
This effort is in addition to a number of actions the Biden Administration is taking to expand access to testing for all Americans. The U.S. Department of Health and Human Services (HHS) is providing up to 50 million free, at-home tests to community health centers and Medicare-certified health clinics for distribution at no cost to patients and community members. The program is intended to ensure COVID-19 tests are made available to populations and settings in need of testing. HHS also has established more than 10,000 free community-based pharmacy testing sites around the country. To respond to the Omicron surge, HHS and FEMA are creating surge testing sites in states across the nation.
For more information, please see these Frequently Asked Questions,
https://www.cms.gov/how-to-get-your-at-home-OTC-COVID-19-test-for-free.html.
For additional details on the requirements, visit
https://www.cms.gov/files/document/faqs-part-51.pdf - PDF.
I didn't know we had a emperor..........................
They’re using covid as an excuse to gain greater control over health insurance.
They’re not increasing access to improve public health.
They’re increasing access to goose the number of positives up in order to keep the scamdemic going.
One aspect to this....when we come to October and the period where the new rates are released for 2023 health insurance, there’s going to be ‘sticker-shock’ to come up and you will be paying 15-to-20 percent more for your yearly heath coverage. Even if you don’t get a single at-home Covid test kit....you are going to be paying for the people in your insurance bracket who did get 350 kits for their family.
Apparently so. Or at least he thinks he can do it. Screw up and NOT order a billion tests and then come back and say, “well, you guys pay for them now” isn’t a plan that comes from a healthy mind. It is a cop out plan from a “get off my lawn” mind.
“Free tests”? Do the Democrats realize that people who buy health insurance end up paying? Are they not capable of grasping the idea that nothing is “free”?
I called a pharmacy. They hadnt heard of this yet ..and havent had tests in over a week. They limit the number you can get when they do have them
This is going to be a huge disaster. Where are my free 8 tests a month..i cant even find one
Good points!
“I’m from the Government and I’m here to help!”............................
Good luck ever finding one if demand stays the way it is and the insurance companies are forced to pay for them.
Nothing is free. Besides, they can’t cover the cost of something that doesn’t exist. Thanks, Brandon. You were warned back in October that COVID tests were going to be in short supply, and you did your usual nothing.
No doubt Fauci and his minions own considerable amount of stock in the suppliers of the kits.
We have an EMPEROR!!!
Just declared that private insurances must change their business to suit him. I think he did this to try to fix the SCOTUS problem, ie that the mandates were unconstitutional. This is the offered alternative to try not to bankrupt workers and businesses that don’t comply. Problem is, the order is unconstitutional, forcing himself into a private contract.
This will force the price of health care coverage way up!! Rates will rise another 20-30% for employers. Along with the inflation, nobody will be able to afford insurance soon. Every time government messes with health care the costs skyrocket and the services shrink.
I am hopeful that a SCOTUS judge would be smart enough to see that unconstitutional order to fix an unconstitutional mandate is still Ann unconstitutional.
Are the tests ‘free’ for those on Medicare? Who pays for that?
Meanwhile the VA has stopped testing all veterans, just those enrolled in “VA Healthcare”. 9,000,000 vets left out in the cold.
Too bad Brandon didn’t make sure there were enough tests ordered.
Incompetent boob.
If somebody’s got to pay for it, it’s not free.
There currently are no tests available that Biden has ordered the insurance companies to pay for because Biden did not fund the plan back in October to get companies to produce the tests. You can’t make this stuff up.
Is this in the Constitution? My copy is faded.
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