The new requirement means that most consumers with private health insurance can buy at-home tests online or in stores and have them paid for at the time of purchase or get reimbursed by submitting a claim to their insurer.
Consumers will not need to visit their doctor or get a prescription to obtain the free tests, the department said. And the tests won’t be subject to copays or deductibles.
Insurers must pay for up to eight tests per covered individual per month. But there won’t be any limit if a doctor orders or administers them after an office visit.
Insurers may set up a network of preferred stores, pharmacies and online retailers, where consumers can receive tests at no cost up front. People could still buy tests outside that network, but insurers would only have to reimburse up to $12 for each one.
The requirement is not retroactive, so at-home tests purchased before January 15 do not qualify for reimbursement.
It is setting up a website and hotline where Americans can request the tests. More details should be available later this week, the White House said.
Health insurers will work quickly, expect ‘hiccups’
Health insurers will implement the guidance as quickly as possible and seek to limit consumers’ confusion and challenges, Matt Eyles, CEO of America’s Health Insurance Plans, known as AHIP, said in a statement.
“While there will likely be some hiccups in early days, we will work with the administration to swiftly address issues as they arise,” Eyles said, while reinforcing the importance of vaccines to fight the coronavirus.
Another major insurer industry group noted the short deadline to launch the program.
“We are concerned that the policy does not solve for the limited supply of tests in the country and could cause additional consumer friction as insurers stand up a program in just four days’ time,” said Kim Keck, CEO of the Blue Cross Blue Shield Association.
Medicaid and the Children’s Health Insurance Program, known as CHIP, already cover at-home tests with no cost-sharing. Medicare covers at no charge Covid-19 testing done in a lab when ordered by a medical professional. Those enrolled in Medicare Advantage plans should check with their insurers to see if at-home tests will be paid for, HHS said.
CNN’s Nikki Carvajal contributed to this story.