How will I be reimbursed for rapid COVID tests? And other FAQs

Consumers lucky enough to get their hands on rapid over-the-counter COVID-19 tests will soon be reimbursed by their insurers for the cost of such devices under new rules defined by the White House this week.

The Biden administration said Monday it would require private insurers to cover the cost of eight home tests per family member each month, in a bid to expand Americans’ access to rapid tests. Although it is widely seen as a step in the right direction, critics of the plan argue that tests are still hard to find, and that they should either be sent directly to Americans or be free at the point of purchase, to ensure equitable access to rapid COVID-19 tests which are now an integral part of the country’s plan to contain the spread of the virus.

That said, the initiative encourages insurers to make testing available at no upfront cost to members by setting up preferred retailer networks that insurance plans will reimburse later.

Read on for answers to frequently asked questions about the initiative.

Who is eligible? What if I am not privately insured?

Under the plan, only Americans who are privately insured can request reimbursement for rapid tests From Saturday, no prescription or prior authorization is required, according to guidelines published Monday by the Department of Health and Social Services.

Americans who are uninsured or covered by Medicare will not be able to claim reimbursement for over-the-counter tests they purchase. Instead, the White House has said it will send 500 million rapid home tests to Americans who will order them through an upcoming government website for free home delivery. The government will also provide 50 million free tests to community health centers and rural clinics for Americans who are not eligible for reimbursement through the federal plan.

Are the tests I have already purchased covered?

No. Consumers will not be reimbursed retroactively for tests they have already purchased. Insurers are only responsible for covering the cost of tests purchased from Saturday January 15th.

What types of tests are covered?

Every variety of over-the-counter COVID-19 test cleared for emergency use by the United States Food and Drug Administration is covered by the new initiative. Approved tests include Abbott’s BinaxNow home test, Quidel’s QuickVue antigen test, and OraSure’s InteliSwab rapid test, among others.

Also on the list is Intrivo’s On / Go test, which was recently ranked among the best by an independent patient safety group that rated a handful of tests based on their ease of use.

ECRI, the independent non-profit organization, gave the test a rating of “very good” in terms of usability. The BinaxNow, QuickVue and InteliSwab tests turned out to have “good” user-friendliness, ECRI reported.

Home test kits could be even more difficult for lay people to administer, the association noted. “We have had scientists and engineers trained to handle complex medical devices evaluate them,” ECRI President and CEO Marcus Schabacker told CBS MoneyWatch.

Where can I buy them?

Rapid home tests remain difficult to find in the United States. “The demand is skyrocketing right now; it is very difficult to find tests. When available, they are immediately retrieved. “

US struggles to meet demand for COVID testing


Rapid tests are available in limited quantities online and in physical stores. Ro health company, once known to address men’s health issues like hair loss and erectile dysfunction, has On / Go testing in stock and allows customers to purchase up to 12 test kits per order. Each kit, which includes two tests, costs $ 30.

Is there a limit to the number of tests I can purchase?

Yes. The Biden administration is requiring insurers to cover the cost of up to eight tests per month, or nearly two tests per week per person.

Will I be automatically refunded the full amount?

It depends. Under the guidelines, the Biden administration is encouraging private insurers to make testing available to members for free at the point of purchase by creating networks of preferred retailers, including pharmacies. Insurers would then reimburse the retailer, rather than the consumer, for the cost of the test.

“The way the language is written, if an insurer sets up a preferred network of retailers, they can use it to provide direct patient coverage at the point of sale,” said Caitlin Donovan, spokesperson for the National Patient Advocate Foundation. “Then they wouldn’t have to ask for reimbursement. Essentially, the insurer would reimburse the seller for these tests.”

If a member purchases a test outside of a preferred network, insurers are only required to reimburse at a rate of $ 12 per test, according to the White House, leaving insured customers online for part of the cost of varieties. more expensive tests.

If no preferred supplier network exists, insurers must reimburse consumers for the full cost they pay for testing. In these cases, privately insured consumers will need to keep their receipts and give them to their insurance company for reimbursement.

“If a supplier doesn’t set up this network, they have to reimburse whatever the purchase price is. It’s the incentive to get them to set up networks,” Donovan added.

Networks also free patients from having to navigate often complex reimbursement systems and procedures.

“The administration encourages insurers to make testing available for free to people without having to go through reimbursement legwork by creating networks so that individuals can simply come in and get tests,” said Lindsey Dawson, testing expert at KFF. .

“About two tests per week per American is certainly more than what the average person in the United States is doing right now. Whether that is enough is something we will have to watch out for,” she added.

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