Insurance Reimbursement
Starting January 15, most people with a health plan can go online, or to a pharmacy or store to purchase an at-home over-the-counter COVID-19 diagnostic test authorized by the U.S. Food and Drug Administration (FDA) at no cost, either through reimbursement or free of charge through their insurance. This applies whether you purchased your health plan on your own or whether you get health insurance through your job.
Insurance companies and health plans will be required to cover eight free over-the-counter at-home tests per covered individual per month, according to White House officials. For instance, 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. However, plans are not required to provide coverage of testing (including an at-home over-the-counter COVID-19 test) that is for employment purposes.
The Biden-Harris Administration is "incentivizing" insurers and group health plans to set up programs that will allow Americans to get the over-the-counter tests (PCR and rapid tests) directly through preferred pharmacies, retailers or other entities with no out-of-pocket costs.
For people whose health care providers have ordered a COVID-19 test, the Biden administration said there will not be a limit on the number of tests that are covered — including at-home tests.
Consumers can find out from their plan or insurer if it provides direct coverage of over-the-counter COVID-19 tests through such a program or whether they will need to submit a claim for reimbursement. If you are charged for your test after January 15, keep your receipt and submit a claim to your insurance company for reimbursement.
Currently, state Medicaid and Children's Health Insurance Program (CHIP) programs must cover FDA-authorized at-home COVID-19 tests without cost-sharing. At this time original Medicare cannot pay for at-home tests through this program. Medicare Advantage plans may offer coverage and payment for at-home over-the-counter COVID-19 tests, so consumers covered by Medicare Advantage should check with their plan.
Learn more about insurance paid at-home COVID tests.
