Insurers are supposed to start paying for COVID-19 tests starting Jan. 15, but many don’t know yet how reimbursement will work

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January 15 is the first day that private health insurance companies will be required to reimburse policyholders for at-home COVID-19 tests they have purchased, according to the Biden administration’s guidance published on Monday.

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However, insurance companies may not have their systems in place until they comply with the new guidance, which was originally announced in early December but was recently finalized.

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The guidance requires private insurers to cover eight rapid COVID-19 tests a month by setting up a network of retailers so that policyholders do not have to pay anything upfront for the tests, or consumers Must be able to submit receipt for reimbursement.

If the policyholder purchases a test from a retailer that is out of network, insurers will only pay up to $12 per test.

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When Businesshala reached out to several of the largest private health insurance companies – including Kaiser Permanente, Aetna CVS,
UnitedHealth Group UNH,
Anthem Antm,
and Signa CI,
– They could not provide any details about how consumers can get reimbursed for tests starting January 15.

“Access to testing has been an important component of our pandemic response. We are reviewing guidance and planning to adjust our coverage policies as appropriate,” Aetna spokesman Ethan Slavin told Businesshala.

“We are reviewing the Biden administration’s recent guidance on reimbursement for at-home COVID-19 tests,” said Mark Brown, a spokesman for Kaiser Permanente. “We are working to make these tests available at no cost to our members through multiple outlets.”

UnitedHealth declined to comment. Cigna and Anthem did not respond to requests for comment.

“Plans and insurers are working rapidly to determine how they will cover or reimburse over-the-counter COVID-19 tests, and may not be able to answer questions until after January,” a spokesperson for the Centers for Medicare and Medicaid Services told Businesshala.

“If a consumer is charged for a test, the person should keep their receipt and submit their health plan claim for reimbursement,” the spokesperson said. “Consumers can find out how to submit reimbursement claims directly from their schemes. Schemes are not allowed to design their reimbursement process in such a way as to unnecessarily delay reimbursement to the consumer.

If you are covered by state Medicaid or Children’s Health Insurance Program (CHIP) programs, you are entitled to receive an at-home COVID test without cost-sharing.

But if you are not insured or covered by Medicare, you can get a free test through the upcoming federal website or through some local community centers and pharmacies.


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