At-Home COVID test costs to be paid by private health plans

At-Home COVID test costs to be paid by private health plans

By Grant Dattilo

On January 10, 2022, the Federal Health and Human Services Department released the following notice about at-home COVID-19 test kits:

“Beginning January 15, 2022, an individual 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…”[i] [Emphasis added]

The government order requires private insurance carriers to cover the cost of the tests if purchased at an in-network provider, even without a doctor’s prescription or other medical order.

  1. Over-the-counter (OTC) tests purchased prior to January 15 are not eligible for reimbursement.
  2. The test costs will be covered at 100 percent at the time of purchase, without regard to cost-sharing or deductibles, if the purchase is made from an in-network
  3. Tests purchased to satisfy employer-directed testing requirements are not eligible for reimbursement.

DCI has been communicating with all insurance carriers and found the following information concerning the in-network retailers that they will approve for this program.

Aetna Aetna is still finalizing their networks. See Aetna’s information webpage (see below) for detail updates.
Blue Cross-Blue Shield of MN Prime Broad Plus Network – 65,000 pharmacies
HealthPartners Call 952.883.5000 for answers
Medica Network pharmacies
PreferredOne Network pharmacies
United Health Care Walmart Pharmacy is the preferred provider

Each covered person (includes spouse and children) is entitled to be reimbursed by their health plan for as many as eight (8) tests per month.

An individual with an insurance plan that includes an in-network provider option who decides to purchase the home test kit outside of the network provider will only be reimbursed up to $12 per test kit. The individual is responsible for any amount greater than $12.

If the insurance company does not have an in-network pharmacy provider option, the individual may purchase a COVID-19 take home test from any retailer and will be reimbursed at 100 percent of the cost, with no $12 limit. However, the individual will be required to file a paper claim directly with the insurance company.

DCI will continue to update you as we hear of changes to this program.

[i] Staff. (2022) Biden-Harris Administration Requires Insurance Companies and Group Health Plans to Cover the Cost of At-Home COVID-19 Tests, Increasing Access to Free Tests.” U.S. Department of Health and Human Services. Washington, D.C. 1/10/2022. https://www.hhs.gov/about/news/2022/01/10/biden-harris-administration-requires-insurance-companies-group-health-plans-to-cover-cost-at-home-covid-19-tests-increasing-access-free-tests.html Accessed 1/11/2022.

Dave Racer
dgracer@comcast.net