Consumers can find out from their plan or insurer if it is providing direct coverage of over-the-counter COVID-19 tests through such a network of preferred pharmacies or retailers.
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The Biden-Harris Administration is also strongly incentivizing health plans and insurers to set up a network of convenient options across the country like pharmacies or retailers, including online retailers, where people can get COVID-19 tests for free at the point of sale, rather than having to submit claims for reimbursement.
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If the plan or insurer does not set up a process through which individuals can obtain test with no upfront costs, then the plan and insurer must reimburse in the full cost of the test, even if the test costs more than $12. Many commercially available at-home tests run about $12 or less per test. Specifically, if a plan or insurer establishes this type of direct coverage option, then the plan or insurer is permitted to limit the reimbursement for tests purchased outside of their network to $12 per test (or the actual price of the test, if less). If a plan or insurer sets up a network of convenient options such as pharmacies or retailers, including online retailers, in which individuals on their plans can get their tests’ cost covered up front (at the point of sale), then it is permitted to limit the per test reimbursement amount for retailers outside of that network. Why would these companies be incentivized to cover the cost up front?.Save your receipt(s) to submit to your plan for reimbursement at a rate of at least $12 per individual test (or the cost of the test, if less than $12). Your plan is required to reimburse you at a rate of up to $12 per individual test (or the cost of the test, if less than $12). If your plan has set up a network of preferred stores, pharmacies, and online retailers at which you can obtain a test with no out-of-pocket expense, you can still obtain tests from other retailers if you buy them outside of that network. For example, if you buy a two-pack of tests for $34, the plan or insurer would reimburse $34. If your plan has not set up a network of preferred stores, pharmacies, and online retailers at which you can obtain a test with no out-of-pocket expense, you will be reimbursed the amount of the cost of the test. If you purchase an over-the-counter COVID-19 test from a pharmacy, store, or online retailer and are charged for your test, keep your receipt and submit a claim to your insurance company for reimbursement. How much will I be reimbursed for an at-home over-the-counter COVID-19 test if I purchase the test upfront and then submit a claim for reimbursement to my insurance company?.If you are charged for your test after January 15, keep your receipt and submit a claim to your insurance company for reimbursement. Consumers can find out from their plan or insurer if it provides direct coverage of over-the-counter COVID-19 tests through such a program or whether they will need to submit a claim for reimbursement. The Biden-Harris Administration is strongly incentivizing health plans and insurers to set up a network of convenient locations across the country such as pharmacies or retailers where people with private health coverage will be able to order online or walk in and pick up at-home over-the-counter COVID-19 tests for free, rather than going through the process of having to submit claims for reimbursement. Will I have to pay for my test up front?.Insurance companies are required to reimburse you at a rate of up to $12 per individual test (or the cost of the test, if less than $12).
If your plan has set up a network of preferred providers at which you can obtain a test with no out-of-pocket expense, you can still obtain tests from other retailers outside that network. Be sure to keep your receipt if you need to submit a claim to your insurance company for reimbursement. The test will either be free directly at the point of sale, if your health plan provides for direct coverage, or by reimbursement if you are charged for your test. This applies whether you purchased your health plan on your own or whether you get health insurance through your job. Food and Drug Administration (FDA) at no cost, either through reimbursement or free of charge through their insurance. Starting January 15, most people with a health plan can go online, or to a pharmacy or store to purchase an at-home over-the-counter COVID-19 diagnostic test authorized by the U.S. How do I get a free at-home over-the-counter COVID-19 test?.
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