Health insurance companies are required to reimburse policyholders for up to eight COVID-19 home tests per person each month, in accordance with federal guidelines released Monday.
Insurers must meet the requirements by January 15th. Health plans cannot enforce cost-sharing or medical management tools, such as prior authorization, that would limit timely access to tests. The guide does not apply to Medicare; Medicaid and the Children’s Health Plan already require free at-home coronavirus tests.
The free testing initiative is part of President Joe Biden’s strategy to contain the nearly two-year COVID-19 pandemic he announced last month. Biden separately plans to mail out 500 million home tests to US households later this month.
“By requiring private health plans to cover the cost of testing people at home, we are further empowering Americans to get tests for free when they need them,” said Health and Human Services Secretary Xavier Becerra. news release…
The government encourages but does not require insurance companies to directly reimburse providers who sell tests to private individuals, which will cut costs for policyholders. This only partially responds to criticism that forcing people to reimburse costs after buying tests themselves will make access more difficult.
Insurance companies choosing this option can limit reimbursements for tests purchased from non-preferred retail stores to $ 12 per purchase, according to guidance. The guidance says health plans must notify beneficiaries whether they offer direct test coverage and which retailers are involved.
“A reimbursement structure that removes barriers to upfront costs will facilitate access to COVID-19 testing and therefore also improve health equity,” it said. management is talking.
Plans are allowed to require proof of purchase, written confirmation that tests are for personal use, or similar policies to combat potential fraud.
Insurers are unhappy. The Alliance for Community Health Plans believes the policy is not true, said Michael Bagel, policy director for a trade group that represents nonprofit insurance companies.
The administration should focus on fixing supply chain problems that prevent people from accessing tests at home, rather than managing how private insurance companies reimburse them, Bagle said. Moreover, he said, the costs should be borne by the federal government, not health plans.
“Home test coverage on top of everything else we cover for COVID – treatments that continue to grow, hospitalizations that increase – is just another unfunded mandate,” Bagle said. The consequences will be higher costs, followed by higher premiums, he said.