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.
you may have my 8 free tests per month every month
My local Walgreens haven’t seen a take home test in weeks. They are on order but nothing. Meanwhile several members of my family are isolating themselves. Closest date so far for test is 1/19.
$46 for me but another $20 for shipping.
they dont have the authority, CMs only controls medicare and medicaide, states have authority over private insurance through state DOI’s
Rates will rise another 20-30% for employers
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Good, many employers have become hated and despised and a known enemy of their employees by supporting, pushing, and blackmailing employees. Those should ALL crash and burn. The CEO’s and managers should be bankrupted, imprisoned, and/or tried as “just doing their job” should Nuremberg 2.0 occur.
First of all, what tests? The local CVS might get one case in and they are gone in a few hours or less.
Secondly, if you aren’t sick with any Coof symptoms, why are people getting tested? It’s insanity.
Strange, no ETA on his 500 million testes he promised and just shuffled away from the podium.
How are you gonna know if you are asymptomatic if you don’t get tested?...................😜
If you have to get tested to even know you have it, it can be that bad particularly with the Omoicron variant, which is like the common cold in almost all cases.
Thanks. Gonna have to schedule one. I’m willing to bet I’ve had it and never known or just assumed it was a cold, like a normal person this time a year.
The tests are NOT FREE! We, the taxpayers are paying for them!
If you can’t find a test kit today, just wait until they are “free”
I didn't know we had a emperor..........................
Brandon dreams that he is King Canute.
Biden is doing this to set the stage for taxing unvaccinated people through the IRS when filing income taxes. Justifying the need to recover taxpayer money “unfairly” spent.
Trampling on states again. We’ll see more law suits filed by states.
Sure sounds like another MANDATE. Probably illegal also.
Yup. A Dr. with the health care group that covers most of this end of my state was on TV news tonight saying the same thing about availability of tests. Even the hospital group's supply for internal use was very tight.
This will drive the price of the kits up as the companies have to recoup their costs.........SOCIALISM DOES NOT WORK!
Nothing is FREE.
I detest Biden and his Comintern group of thugs.
Right! By making insurance companies pay for it. Yes, free just like in the by two get one for free [small reasonable charge for postage and handling] scams.
That is only half of it. The other half is that the crony capitalist businessesw like such orders because they are highly profitable.
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