Private health insurers are rolling their procedures for people to get their at-home Covid tests at little to no charge.
The Biden administration announced the policy toward the end of last year ordering insurers to reimburse those they cover for the tests, and additional guidance was put out this month. In addition, free tests are now available by mail to millions of Americans, regardless of their insurance status.
The program for those who are privately insured will allow for up to eight tests a month per person, and the tests should be accessible at local pharmacies and online. But each plan has its own quirks.
Here’s what you need to know.
Do all insurance plans have to cover the tests?
The answer is no.
The 150 million Americans who have private health insurance are eligible. That includes people insured by their employer, as well as those who’ve bought a plan on the Affordable Care Act’s marketplace, said Lindsey Dawson, a policy expert at the Kaiser Family Foundation.
Those covered through Medicare will not be reimbursed under this program. Medicaid enrollees may benefit from the initiative, with some states setting up a reimbursement mechanism, but you should check with your state for more information.
Short-term or health-care sharing plans don’t have to participate in the government program, said Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University’s McCourt School of Public Policy.
How does it work?
It varies by insurer.
Depending on your provider, you’ll either be able to get the tests at no upfront cost or you’ll need to lay out for them and then file for reimbursement. In a recent review of policy plans, the Kaiser Family Foundation found that about half of insurers are allowing for “direct coverage,” and half are requiring their enrollees to go through the reimbursement process.
You should call your insurer or look on their website to find out your options.
If you can get an over-the-counter test without paying for the cost, your insurer will likely have a list of preferred retailers where you can do so. For example, United Health Care’s spots include Walmart and Sam’s Club.
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If you’re going the reimbursement route, make sure you hold on to your receipt, said Caitlin Donovan, a spokesperson for the Patient Advocate Foundation
“Your normal receipt should be fine — I’ve even printed out receipts from Amazon — and then you would have to send it in,” said Donovan.
Many insurers are currently requiring the reimbursement forms be mailed to them. Other options include fax and online submission. Some insurers are requiring enrollees to submit product barcode information, as well as your receipt, Dawson said.
Keep in mind at-home Covid tests are also an eligible expense for flexible savings accounts and health savings accounts.
Can I get any test?
Most at-home Covid tests that you can buy online or at a pharmacy will be covered under the policy, as long as it’s approved by the U.S. Food and Drug Administration.
“For insurers with a direct coverage option, those tests should be covered in full so someone buying one would not have to worry about a price cap,” Dawson said.
If you buy a test outside your insurer’s preferred network, however, you may only be reimbursed as much as $12 per test.
If your insurer hasn’t set up a way for its enrollees to buy the tests with no upfront costs, which you should find out if they have, you should be reimbursed for whatever you paid for the test.
How many tests can I buy?
You should be allowed to buy at least eight tests a month under the policy. A family of four would be entitled to 32 tests a month.
What if I don’t have private health insurance?
The federal government will be providing up to 50 million free, at-home tests to community centers and Medicare-certified health clinics. You should be able to find one of these centers at your state or local health agency’s website.
What’s more, the Biden administration has purchased more than 500 million over-the-counter tests that are available to all Americans by home-delivery that they can request on a website. Each household can currently order four tests.
When should I use an at-home test?
Dawson cited some of the most common circumstances in which people may want to test themselves for the virus: They’ve come into contact with someone diagnosed with Covid, they’re displaying symptoms of the virus or they’re expected to attend a high-risk event, such as a big family gathering or one in which someone immunocompromised will be present.