Starting January 15th, 2022 private insurers will have to cover the cost of eight at-home coronavirus tests per member per month. Individuals will be able to obtain tests at their health plan's 'preferred' pharmacies with no out-of-pocket costs. If obtained at an out-of-network facility, insurers' responsibility would be capped at $12 per test.

If a health plan does not establish a network of 'preferred' retailers, the full price of the test would be reimbursed by the carrier. Tests ordered or administered by health providers will continue to be covered without any co-payment or deductible.

While manufacturers are racing to restock shelves, the low availability could hinder the rollout of the reimbursement policy in its early days. The reimbursement policy is intended to exist for the duration of the Covid-19 public health emergency.

The Biden administration is trying to secure 500 million at-home tests to be distributed.

How to get FDA-approved rapid antigen home tests

• Starting January 19, you can request free rapid antigen tests, without shipping fees, from the federal government.
• USPS offering 4 home tests per residence.

Carrier specific communications thus far are as follows:

Cigna:

In order to be reimbursed, customer claims can be submitted by following the directions on the back of the customer’s Cigna ID card. The submission needs to include:

1. The purchase receipt documenting the date of purchase and the price
2. UPC code for the OTC COVID-19 test
3. Signed, completed attestation stating the test:

• is not for employment purposes;
• has not and will not be reimbursed by another source, and
• is not for resale.

United Healthcare:

UnitedHealthcare’s initial preferred OTC retailers for COVID-19 at home tests are Walmart Pharmacy, Rite-Aid, and Bartell Drugs. Where members may show their ID card and then do not have to pay an up-front cost or submit a claim form for subsequent reimbursement. More preferred retailers are expected to be added soon. When COVID-19 at home tests are purchased at any in-store or online retailer, other than the in-store Walmart Pharmacy, members may submit their receipt(s) for reimbursement through the UnitedHealthcare member portal. UnitedHealthcare will reimburse the member a maximum of $12 per test.

Kaiser:

Following guidance from the Biden administration, Kaiser Permanente will now reimburse members for FDA-approved rapid antigen home tests. Submit a reimbursement claim online for tests purchased on or after January 15, 2022.

More updates to come...