Starting Saturday, new federal rules will require private insurers to cover the at-home coronavirus tests that Americans buy in pharmacies and other stores. The new system could, in theory, allow millions of consumers to pick up tests at thousands of locations without spending any money.
Then on Wednesday, Jan. 19, people can order tests directly, online at COVIDTests.gov.
Public health experts and the Centers for Disease Control and Prevention recommend that Americans use at-home tests if they begin to have symptoms, at least five days after coming in close contact with someone who has COVID-19, or are gathering indoors with a group of people who are at risk of severe disease or unvaccinated. Federal health officials say testing is an important tool to help mitigate the spread of COVID-19.
To help ensure Americans have tests on hand if a need arises, the Biden Administration is purchasing one billion at-home, rapid COVID-19 tests to give to Americans for free. A half-billion tests will be available for order Jan.19 and will be mailed directly to American households.
There will be no charge for the initial tests,and to promote broad access, the initial program will allow four free tests to be requested per residential address. Americans will be able to order their tests online at COVIDTests.gov, and tests will typically ship through the U.S. Postal Service as first-class mail within 7-12 days of ordering.
To ensure equity and access for all Americans, the Administration will also launch a call line to help those unable to access the website to place orders, and work with national and local community-based organizations to support the nation’s hardest-hit and highest-risk communities in requesting tests.
The administration is also setting up a hotline where people can request the free tests be mailed to them, but the number was not immediately available Friday.
This program will ensure that Americans have at-home, rapid COVID-19 tests available in the weeks and months ahead—in addition to the number of other ways they can get tested.
The Department of Defense, in coordination with the Department of Health and Human Services, has already awarded several of the contracts that will result from this process—with over 420 million tests already under contract. Given the high volume of tests being procured and the diversity of manufacturers, additional contracts will continue to be awarded over the coming weeks.
The Biden Administration continues acting aggressively to further increase equitable access to free COVID-19 testing for all Americans, as testing needs arise. This includes:
- Requiring health insurers to cover the cost of at-home COVID-19 tests starting Jan.15: Private insurance companies will be required to cover at-home COVID-19 tests. This means consumers with private health insurance coverage will be able to get these tests for free. Insurance companies and health plans are required to cover eight free at-home tests per covered individual per month. That means a family of four, all on the same plan, would be able to get 32 of these tests covered by their health plan per month. As part of the requirement, the Administration is strongly incentivizing plans and insurers to allow people to get these tests directly through preferred pharmacies or retailers with no out-of-pocket costs, with the plan or insurer covering the cost upfront, eliminating the need for people to submit reimbursement claims.
- Making 10 million more tests available to schools nationwide each month: This includes increasing the number of COVID-19 tests available to schools by 10 million per month to help schools safely remain open and implement screening testing and test-to-stay programs—which will allow schools to double the volume of testing they were performing in November 2021—and supporting free testing access for students, school staff, and families through federal testing sites.
The Biden Administration has already expanded school testing, including providing states $10 billion in American Rescue Plan funding to support COVID-19 screening testing for teachers, staff, and students and $130 billion in American Rescue Plan funding that schools can use on COVID-19 testing. In addition to these resources, at the President’s direction, FEMA has been providing states, Tribes, and territories 100 percent federal reimbursement to support COVID-19 testing, including at schools. There was no federal support for testing in schools prior to the start of the Administration.
Starting last February, the Administration has used the Defense Production Act, industrial mobilization and advance purchase commitments to ramp up supply of testing, including at-home, rapid tests. This includes $3 billion in advance purchase commitments this Fall, which allowed domestic testing manufacturers to increase production, add factory lines, increase staffing, and move up manufacturing timelines.
As a result, the U.S. went from 24 million at-home, rapid tests on the market in August, to 46 million in October, to 100 million in November, to over 300 million in December, to 375 million in January. This is on top of the work the Administration has done to increase capacity for lab-based COVID-19 testing; the U.S. is now conducting more lab-based tests per capita than many peer countries, including Germany, Canada, and Japan.
The new round of tests won’t be subject to copays or deductibles.
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.
Consumers should contact their insurers to find out if they provide direct coverage or if claims must be submitted.
Insurers must pay for up to eight tests per covered individual per month. So a family of four could get 32 tests each month. Medicaid and the Children’s Health Insurance Program, known as CHIP, already cover home tests with no cost-sharing.The uninsured can get free home tests from certain community health centers. They
can also request tests through the federal program once it becomes available.
The reality, at least in the short term, is likely to be messier: Some insurers say it will probably take weeks to fully set up the system the White House envisions.
The new process will be hard, the insurers say, because over-the-counter coronavirus tests are different from the doctor’s visits and hospital stays they typically cover.
The tests do not currently have the type of billing codes that insurers use to process claims. Health plans rarely process retail receipts; instead they’ve built systems for digital claims with preset formats and long-established billing codes.
Because of this, some insurers plan to manage the rapid test claims manually at the start.
Some local governments in the United States have invested heavily in rapid testing to counter the latest wave of cases. Washington, D.C., which has experienced a substantial surge in virus cases, now allows residents to pick up four free rapid tests daily at libraries across the city.
The new rules require private insurers to cover eight at-home coronavirus tests for each person, every month. The rules will not apply retroactively to at-home tests that Americans have already purchased, and do not cover patients with public insurance such as Medicare and Medicaid.
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Even as insurers sort out systems for processing claims, they noted one major factor will remain out of their control: testing supply, and the shortages that consumers have confronted in recent weeks.
The New York Times, the White House and CNN contributed to this story.