Insurers and health plans to cover COVID-19 at home tests:
A recent announcement from the federal government intends to increase access to COVID-19 testing. As of January 15, 2022, members can get reimbursed by their health plan without cost share for the costs of over-the-counter diagnostic COVID-19 tests until the end of the Coronavirus Public Health Emergency. Diagnostic tests are performed if members are experiencing COVID-19 symptoms or have been recently exposed.
When should a member take a test?
The Centers for Disease Control and Prevention (CDC) provides guidelines for who should get a diagnostic test and when based on their current health vaccination status and history of infection.
Note that the at home test for COVID-19 doesn’t replace the need of seeking medical attention. Please follow your doctor’s prompts when feeling sick regardless of the test results.
Where can members find a test?
- Visit COVIDtests.gov for information on free tests that may be available through government programs.
- Members can still use in-person diagnostic COVID-19 testing sites. These may include a doctor’s office, a pharmacy or health clinic, or an urgent care center.
- Over-the-counter diagnostic tests can be purchased online, at a local pharmacy, or from a big-box store.
Can members visit the emergency room for a test?
As hospitals and emergency departments are overwhelmed, members should avoid going to the emergency room (ER) if they need to get tested. They should only visit the ER or call 911 if they’re experiencing life-threatening symptoms.
The at home test should help in increasing awareness about infected people and increase insulations to minimize the spread of the virus. Visiting the emergency room just for a COVID-19 test may not be as reasonable since the wait times at the ERs are higher than normal.
How are the over-the counter tests covered?
From January 15, 2022, until the end of the Coronavirus Public Health Emergency, each member on a group plan can get up to eight over-the-counter tests each month. If members purchase a test kit that includes two rapid tests, that will count as two of their eight covered tests. The federal requirement covers their cost for diagnostic tests.
Beginning January 15, 2022, individuals with private health insurance coverage or covered by a group health plan who purchase an over-the-counter COVID-19 diagnostic test authorized, cleared, or approved by the U.S. Food and Drug Administration (FDA) will be able to have those test costs covered by their plan or insurance. Insurance companies and health plans are required to cover 8 free over-the-counter at-home tests per covered individual per month. That means a family of four, all on the same plan, would be able to get up to 32 of these tests covered by their health plan per month. There is no limit on the number of tests, including at-home tests, that are covered if ordered or administered by a health care provider following an individualized clinical assessment, including for those who may need them due to underlying medical conditions.
What to do if I’m feeling sick after a positive at home test?
If you are feeling sick or exhibiting moderate to severe symptoms like Shortness of breath, chest pain, body aches, high fevers you should go to the nearest hospital or call 911. Your health insurance should still cover for medical services resulted from sickness due to COVID-19.
If you are not insured, you may be eligible for other programs like Medicaid if you meet the income criteria. Or if you just lost your job or lost health insurance coverage you may be eligible for a special enrollment period to enroll in a health insurance plan that covers your health services.
United Healthcare Update for their Members:
On Jan. 15, 2022, UnitedHealthcare began covering most commercial individual and group health plan members’ FDA-authorized or approved OTC COVID-19 at home tests without a doctor’s prescription or clinical assessment. This COVID-19 at home test benefit includes up to 8 tests per member per 30 days.
UnitedHealthcare fully insured and Level Funded individual and group health plan members will have two ways that they can receive reimbursement for these COVID-19 at home test kits.
- Preferred Retailers — UnitedHealthcare has developed and deployed a solution of Preferred Retailers for coverage of OTC COVID-19 at home test kits. A Preferred Retailer is a pharmacy that UnitedHealthcare has made arrangement with to provide an OTC COVID-19 at home tests at no cost to the member at time of purchase or later. The list of Preferred Retailers and their websites may be found in the Preferred Retailer list on uhc.com. UnitedHealthcare is working to add additional Preferred Retailers.
- Other retailers or online — If the member purchases a COVID-19 at home test at any in-store or online retailer other than at the in-store pharmacy counter, they may submit purchase receipt(s) for reimbursement at the UnitedHealthcare member portal for a maximum reimbursement of $12 per test. Many COVID-19 tests are sold as a two-pack so that means the test pack would be reimbursed at $24 ($12 for each test).
A member must be a UnitedHealthcare commercial individual or group health plan member and have UnitedHealthcare’s Pharmacy benefit to purchase OTC COVID-19 at home tests at the Preferred Retailer at no cost using their UnitedHealthcare member ID card. As mentioned earlier, the member may also purchase and then submit a receipt for reimbursement at the retail location of their choice.
Other self-funded customers will receive a communication shortly that will outline the program and options for their business and members.
