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

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.

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.

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.

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.

“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.”

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.

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.

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.