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Will ACA-compliant health plans cover the cost of at-home COVID tests?

Will ACA-compliant health plans cover the cost of at-home COVID tests?

As of January 15, 2022, your ACA-compliant health insurance plan will cover the cost of up to eight at-home COVID tests for each person on your plan.

The new regulations were intended to make at-home COVID tests more accessible for most Americans. But as the Blue Cross Blue Shield Association noted in a statement about the new guidance, at-home COVID tests were still in short supply in many areas at the time, and insurers only had four days to bring their systems into compliance with the new rules, which is a particularly tight schedule. That’s especially true given that everything about this program was new; billing codes and reimbursements systems for over-the-counter COVID tests had to be created from scratch, and insurers generally didn’t already have systems in place for covering over-the-counter purchases.

There were some hiccups in the early days, both in terms of supply issues at local and online stores, and how health plans made the program work for their enrollees. But health plan members should rest assured that the coverage rules will ensure that they do have access to free at-home COVID tests for the remainder of the pandemic emergency period. (The pandemic emergency period is updated every 90 days and was most recently extended through mid-October 2022.)

What health plans cover at-home COVID tests?

Most health coverage in the U.S. covered at-home COVID tests as of January 15, 2022. This includes employer-sponsored plans and individual market major medical plans (both on-exchange and off-exchange), including grandmothered and grandfathered plans. It also includes Medicaid and CHIP.

The new rules did not initially apply to Medicare. Thankfully, CMS announced in February that all Medicare beneficiaries with Part B (including both Original Medicare and Medicare Advantage beneficiaries) would be able to start obtaining up to eight at-home COVID tests per month at participating pharmacies, without having to pay for the tests. This benefit was available as of April 4, 2022.

But the new rules do not apply to short-term health plans, or to plans that aren’t considered health insurance, such as health care sharing ministry plans and direct primary care plans.

How can I get free at-home COVID tests through my health insurance plan?

You should contact your health plan to see if they have specific pharmacies, websites, or stores where they’ll allow you to obtain COVID tests without paying anything upfront. That’s the easiest and most hassle-free approach, and it’s the approach that the government is encouraging health plans to use. But your health plan might tell you that you need to purchase tests and then submit your receipts for reimbursement. Either way, you’ll need to follow their instructions in order to utilize this new benefit.

Be aware that if your health plan has set up a network of pharmacies where you can obtain COVID tests with no upfront costs and you choose to go outside that network to purchase tests, your health plan might not reimburse you for the full cost. In that case, the insurer only has to reimburse you up to $12 per test ($24 for a two-pack).

But if your insurer doesn’t offer any locations where you can obtain zero-cost COVID tests (either online or at local stores or pharmacies), you can go to any retail location that sells COVID tests, purchase the tests, and submit your receipt for full reimbursement from your health plan (this unlimited reimbursement requirement incentivizes health plans to make sure that they have options in place for members to obtain tests with zero upfront costs, as they’ll otherwise have no way to cap the amount that they pay for members’ COVID tests).

Can I get more than one COVID test at a time through my health insurance?

Yes. The new rules require insurers to cover up to eight tests per member per month. If the tests are sold in two-packs, you’ll be able to get four of those two-packs each month for each person on your health plan.

You can pick up all of the tests at once, or spread them out through the month; the coverage under your health plan will be the same either way. You might find, however, that the pharmacy or store limits the number of COVID tests you can buy at once, if they’re experiencing shortages.

Do I need a doctor's authorization to get free at-home COVID tests through my health insurance?

No, you do not need any sort of prescription or doctor’s authorization to get free at-home COVID tests through your health insurance plan. However, if your doctor orders the tests or administers the tests, the limit of eight covered tests per month does not apply.

In other words, if your doctor believes that you need additional tests and either performs them or writes a prescription for them, your health plan will generally cover as many as the doctor orders.

Can I get reimbursed for COVID tests I purchased before January 15?

Under the new regulations, health plans are not required to cover at-home COVID tests purchased prior to January 15, 2022, unless they were prescribed by a doctor.

Your health plan might voluntarily agree to cover that cost, however, so it’s a good idea to contact your health plan and see if it’s possible to submit receipts for tests you purchased before January 15.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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