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Beginning tomorrow, Jan. 15, the Biden-Harris Administration’s “Path Out of the Pandemic” COVID-19 Action Plan, is requiring insurance companies to cover the cost of over-the-counter, at-home COVID-19 tests. Individuals are eligible for eight free tests each month.

Under the new plan, individuals will be able to receive up to eight tests each month to monitor for COVID-19 infection. Therefore, a family of four would be eligible for up to 32 tests each month.

If a health care provider orders or administers testing, there is no limit to how many free tests one may receive, so long as they have been ordered by the health care professional. This is especially helpful for those with underlying health concerns.

“Under President Biden’s leadership, we are requiring insurers and group health plans to make tests free for millions of Americans. This is all part of our overall strategy to ramp-up access to easy-to-use, at-home tests at no cost,” said HHS Secretary Xavier Becerra. “Since we took office, we have more than tripled the number of sites where people can get COVID-19 tests for free, and we’re also purchasing half a billion at-home, rapid tests to send for free to Americans who need them. By requiring private health plans to cover people’s at-home tests, we are further expanding Americans’ ability to get tests for free when they need them.”

Private or Group Insurance

Most people who have private health insurance will be able to obtain over-the-counter at-home COVID-19 tests, either in-person or online, and it will be covered up-front by their insurance company. Others may need to be reimbursed by submitting a claim, however, insurers have been incentivized to cover the costs upfront. This means no out-of-pocket costs for consumers, including copays or deductibles, would apply to the COVID-19 tests.

Tests that are obtained through an out-of-network establishment still must be reimbursed but at a rate of up to $12 per test.

“Testing is critically important to help reduce the spread of COVID-19, as well as to quickly diagnose COVID-19 so that it can be effectively treated. Today’s action further removes financial barriers and expands access to COVID-19 tests for millions of people,” said CMS Administrator Chiquita Brooks-LaSure.

Those without Private/Group Insurance

Other actions being taken by the current administration are also helping to ensure that Americans have access to testing. The U.S. Department of Health and Human Services (HHS) is providing up to 50 million free, at-home tests to community health centers and Medicare-certified health clinics for distribution at no cost to patients and community members, according to the official news release from the U.S. Department of Health and Human Services. This program is important to bring equity to areas that may not have much access to tests.

HHS also has established more than 10,000 free community-based pharmacy testing sites around the country. To respond to the Omicron surge, HHS and FEMA are creating surge testing sites in states across the nation, per the news release.

Medicaid, Medicare and CHIP Programs

The news release explained that “State Medicaid and Children’s Health Insurance Program (CHIP) programs are currently required to cover FDA-authorized at-home COVID-19 tests without cost-sharing. These programs must cover all types of FDA-authorized COVID-19 tests without cost-sharing under CMS’s interpretation of the American Rescue Plan Act of 2019 (ARP).

“Medicare pays for COVID-19 diagnostic tests performed by a laboratory, such as PCR and antigen tests, with no beneficiary cost-sharing when the test is ordered by a physician, non-physician practitioner, pharmacist, or other authorized health care professional.”

People who are enrolled in a Medicare Advantage plan can check to see if their plan offers payment for at-home over-the-counter COVID-19 tests.

Useful Information for Obtaining At-Home COVID-19 Tests

A detailed list of how you can get at-home, over-the-counter COVID-19 tests for free is available online at the website.

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.

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