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.
This is simply an effort to make his OSHA edict more palatable to the Supreme Court.
You may be required to do BOTH.....................
I never thought of that... I haven’t any breakfast yet...
Government ordering private business around is fascism.
Many are made in China.
Perhaps the Supreme Court should reserve one day a week for the Brandon Administration.
The only test I want from the VA is an antibodies test. They refuse. Some have acted like they have never even heard of such a thing.
I’m curious how this works. I’m with an HMO does that mean I’d have to get it at their pharmacies? Or do I have to get reimbursed? Also, why didn’t he do this a year ago?
1. Create the problem
2. Promise to fix the problem
3. Gather new powers while never1 fixing the problem
4. Blame it on the new problem that needs fixing.
I sure hope insurance companies band together and fight this edict.
everything is free, free, free!!!
Hey everyone, get the free stuff here!!
Just another one of Joey’s pass the buck gigs with his logic he thinks the companies can increase their rates and make more money.
It’s how the democrat buddy system has worked for years.
So let me see if I have this right. The “Government” creates a crisis by outsourcing illegal bio-weapon research to China, China F-s up by letting the illegal bio-weapon escape and infect the world, then the DNC media gets every “Karen” in the country so spun up they have to run around and get tested three times a week and we run out of tests. Now too cover the Biden cabal’s lack of any governing acumen they order the private sector to fix a problem they created and everyone is supposed to give them a standing ovation. That about cover it?
Pretty much............................
Another factor is that people don’t trust the accuracy of these tests. As a result this will motivate people to get repeat tests which adds to the costs that will passed along in the form of increased insurance premiums.
Personally I like the idea of on-demand home testing for as many illnesses and diseases as possible. But it should be an extra cost or rider to a policy.
“I didn’t know we had a emperor...”
CVS $69
“The only test I want from the VA is an antibodies test. They refuse. Some have acted like they have never even heard of such a thing”.
Same here.
I go in for blood tests once a year and am to the point that I don’t really trust them, either.
I’ll stick with the VA because they will pay for such things as colonoscopies at our local hospital. Tri-Care handles that through Choice.
Trump improved the VA so much and now they’re going down hill again..
FJB, FHUH
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