White House Says Private Insurers to Cover Rapid Covid-19 Tests

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From Saturday, insurance companies will have to cover eight rapid COVID-19 tests in a month

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As per the new policy, consumers with private insurance will be able to avail tests without any cost-sharing such as deductibles, coinsurance or copayments. For example, a family of four on the same health plan would be able to be reimbursed by their insurance for 32 tests a month.

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The Biden administration is encouraging insurers and group health plans to establish partnerships with specific retailers and pharmacies so that people can get free tests directly over the counter without paying upfront or submitting a claim for reimbursement.

If insurers establish such programs, they will still be required to reimburse people for tests purchased outside of those networks, but the reimbursement rate will be limited to $12 per test. A person must pay the difference if they purchase a test outside of their insurer’s network, such as through an online retailer, and if the cost of the test exceeds $12.

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Right now, many over-the-counter tests cost about $12 per test, for about $24 in a two-pack, but some cost more.

Consumers can find out from their plan or insurer whether it offers direct coverage of over-the-counter COVID-19 tests or whether they will be required to submit a claim for reimbursement, officials said. The new policy does not apply to Medicare, its more than 60 million senior citizens who are generally at higher risk of serious infections because of their age. Medicaid already covers home COVID-19 tests that have been authorized by the Food and Drug Administration.

Some insurer groups said on Monday that the administration should have done more to make testing available and affordable.

“The lack of a two-year coordinated national testing strategy in this public health emergency leaves many communities without the resources needed to mitigate this virus,” said Ceci Connolly, president and chief executive of the Coalition for Community Health Plans. plans.

She said the policy released on Monday did not address the major problems facing widespread use of home tests, including lack of availability at pharmacies and retailers, delays in shipping tests and some early signs of pricing.

There have been complaints to the government of some retailers raising prices as a result of a lack of home tests amid the spread of the Omicron version, as people search for the test they need to return to work and school. Some families have said they have spent hundreds of dollars on tests in recent weeks.

Public health leaders say it is important to make diagnostic tests more abundant and affordable to prevent the spread of COVID-19 because people identified as infected can be isolated and help reduce transmission. can, as well as potentially receive treatment. The virus can cause asymptomatic or mild infections in which people are unaware that they can transmit COVID-19 to others, even in individuals who have been vaccinated and who have received a booster shot. have met. People can also be contagious before they develop noticeable symptoms.

Sabrina Corlett, co-director of Georgetown University’s Center on Health Insurance Reforms, said the new insurance requirement will enable more people to get tested.

“This policy will help lakhs of families to take the Covid test which allows them to stay in school, meet family members and live their lives,” she said. “It’s not perfect, and there will be glitches, but the cost of these tests has been a major deterrent for many people, and this policy helps reduce that.”

Currently, insurers are covering tests that have been prescribed, administered, analyzed or otherwise involve a physician. Officials said there is no limit to the number of tests, including home tests, that must be covered by insurers when they are ordered or administered by a health provider.

The administration is also expected to introduce a new website soon where people requesting a free trial can be mailed to them. US officials are seeking to distribute 500 million free home tests starting this month.

According to some health-policy analysts, it may still fall short of expected demand.

“Given the increase in cases, five hundred million isn’t really enough,” said Larry Levitt, executive vice president of health policy at the Kaiser Family Foundation.

The Food and Drug Administration recently allowed two large manufacturers to sell their over-the-counter tests in the US, and public-health and clinical experts predict supply will increase in the coming weeks. .

The new coverage requirements are outlined in guidance from the Centers for Medicare and Medicaid Services at the Department of Labor and the Department of Health and Human Services.

According to a person familiar with the plan, the administration will take a call on Tuesday with insurance companies regarding the requirement.

Write Stephanie Armour at [email protected] and Brianna Abbott at [email protected]

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