Payers must cover at-home COVID-19 tests starting Jan. 15

Private insurers must cover the cost of up to eight at-home COVID-19 tests per month effective Jan. 15, according to an HHS news release.

President Joe Biden initially announced the move in December as part of his plan to combat the spread of COVID-19, but did not announce final rules or an implementation date. 

Under the new guidance, a family of four covered by a private or group insurance plan is eligible for up to 32 at-home tests total — up to eight per person. There is no limit on how many tests an insurer must cover if the test is administered by a provider following a clinical assessment, according to the news release. 

The Biden administration is encouraging payers to create programs that encourage members to use their preferred pharmacies to get at-home tests, which cuts out the need for members to submit reimbursement claims. 

If such a program is set up and members purchase a test elsewhere, payers must reimburse them for the cost of the test, up to $12. The rule addresses payer concerns that President Biden's plan would result in widespread price gouging. 

"The Biden Administration's testing guidance protects insurers against price gouging by unscrupulous retailers, but only if the insurance company provides a way for consumers to get at-home tests for free at pharmacies with no upfront payment," Larry Levitt, Kaiser Family Foundation executive vice president for health policy, said on Twitter.

However, payers still raised concerns. Alliance of Community Health Plans President and CEO Ceci Connolly said President Biden's rule does not address issues with at-home testing like shipping delays, supply chain issues and potential price gouging, according to a news release shared with Becker's

"We have long called on the Administration to prioritize available and affordable testing for every American," Ms. Connolly said. "We appreciate our ongoing, constructive conversations with the Administration regarding test accessibility and our shared goals to protect the American public."

"However, the lack of a coordinated national testing strategy two years into this public health emergency leaves too many communities without the resources necessary to mitigate this virus. There are alternatives available to improve access to at-home tests, but this ill-conceived guidance misses the mark."

For additional guidance from HHS, click here.

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