COVID-19 rapid antigen test
Source: Getty Images

How to Claim COVID-19 Tests on Health Insurance: Info on New Policy

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Jan. 11 2022, Published 3:45 p.m. ET

The Biden administration announced on Jan. 10 that insurers will have to cover eight free at-home COVID-19 tests per member per month starting on Jan. 15. Also, the U.S. Department of Health and Human Services (HHS) explained in a press release on Jan. 10 how to claim COVID-19 tests on health insurance—and how many individuals won’t even need to.

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According to HHS, individuals will be able to get the COVID-19 tests at their health plan’s preferred pharmacies and other retailers and have the tests covered upfront without paying anything out of pocket. Individuals can also get reimbursed up to $12 for COVID-19 test purchased elsewhere.

How are the COVID-19 tests covered under the new policy?

Beginning on Jan. 15, individuals covered by private health insurance or a group health plan can purchase over-the-counter COVID-19 tests authorized, cleared, or approved by the FDA and have the costs covered by their plan or insurance.

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COVID-19 rapid antigen test
Source: Getty Images

Each individual on the plan is entitled to eight of these tests per month, which means that a family of four on the same insurance plan can have 32 tests covered every month, as HHS explains. There isn't a limit for tests that are covered by insurance if the tests are ordered by a healthcare provider who conducted an individualized clinical assessment on the given individual.

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“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,” HHS Secretary Xavier Becerra said in a statement on Jan. 10. “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.”

How individuals can get reimbursed for COVID-19 tests.

HHS says that the Biden administration is incentivizing insurers and group health plans to cover over-the-counter COVID-19 tests upfront with no out-of-pocket costs when purchased directly through preferred pharmacies or other retailers, which means that individuals wouldn’t have to submit a claim for reimbursement.

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These same plans and insurers are still required to reimburse covered individuals for COVID-19 tests purchased elsewhere, up to $12 per test. For those purchases, HHS advises consumers to check with their plan or insurer for more information about reimbursement.

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The new guidance from the Biden administration came on the same day that the U.S. reported 1.35 million new COVID-19 cases, according to Reuters. This is a record daily total for any country in the world and the highest tally in more than a year.

“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,” Chiquita Brooks-LaSure, the administrator of the Centers for Medicare & Medicaid Services, said in a statement on Jan. 10.

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