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MADISON – Starting Saturday, Jan. 15, health insurance plans in Wisconsin will be required to cover the cost of over-the-counter, at-home COVID-19 tests for their members.

The new requirement was announced Thursday by the state Office of the Commissioner of Insurance and Gov. Tony Evers’ office. The guidelines, as outlined by the Biden Administration, require at-home COVID-19 tests to be free or reimbursed by insurers. Health plans and insurance companies are incentivized to set up a network of pharmacies or retailers so their members can conveniently order or pick up these tests that will be covered up front.

At-home COVID-19 tests have recently been in short supply at many pharmacies because of high demand from increasing cases of the COVID-19 Omicron variant.

“Access to testing is critical as Omicron continues to spread through our communities,” state Insurance Commissioner Nathan Houdek said in a news release. “This new requirement will help stop the spread of COVID-19 by making it easier for everyone to test themselves at home.”

Insurance Coverage for COVID-19 Tests

Under the new requirement, health plans or private insurers that establish a network of pharmacies or retailers are permitted to limit the reimbursement for tests purchased outside of that network to $12 per test. For example, if a consumer chooses to purchase a two-pack of COVID-19 tests online through an out-of-network retailer for $34, then they may only be reimbursed $24 for the cost of two tests.

If a health plan or insurance company does not set up a network to prevent upfront costs for their members, then they must reimburse the full cost of the test, even if the test costs more than $12. Plans are required to cover eight individual tests per month for each person covered by the plan.

Health plans and insurance companies are not required to cover nor reimburse the cost of testing that is not diagnostic in nature. For example, a health plan is not required to cover COVID-19 tests that an individual takes on a regular basis as a condition of employment.

Uninsured Wisconsin residents also have at-home testing options. The state has teamed up with Vault Medical Services to offer COVID-19 tests for everyone who lives in Wisconsin, with or without symptoms, at no cost. This new service allows people to collect their own saliva samples for testing in their homes. Visit COVID-19: At-Home Collection Kit to learn more.

The Racine County Eye and Kenosha Lens is committed to publishing the most current and accurate information regarding the COVID-19 pandemic in our Coronavirus section. View both the Racine County COVID-19 Dashboard and Kenosha County COVID-19 Dashboard offering real-time (updated Monday – Friday) statistical reporting for Racine and Kenosha Counties.

Paul Holley is retired from careers in journalism, public relations and marketing but not from life. These days, he pretty much writes about what he feels like writing. You may contact him directly at:...