President Joe Biden announced this week that as of January 15, individuals with private health insurance or covered by a group health plan are able to have at-home COVID tests covered, but the catch is you cannot get any tests covered that were purchased before that time -- which is when many of us affected by the omicron surge cleared store shelves for rapid tests.
"It would make sense if they would allow us to either retro bill it or, for the patients that saved their receipts, to submit it for reimbursement," said David Yoon, who owns US Pharmacy Lab in Northvale. "I don't understand why they wouldn't allow that."
He said while insurers were previously rejecting coverage for COVID tests, ringing up kits this week has been seamless.
"In your case, this particular brand was covered," Yoon said.
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Aetna automatically paid in full with a $0 copay for eight of the FDA-approved nasal swab kits.
It's eight tests per month, per person, so if you have a family of four, that's 32 tests per month.
As part of the administration's new plan, there's no need for a health care provider's order or individualized clinical assessment, and no cost-sharing requirements such as deductibles, co-payments or coinsurance, prior authorization, or other medical management requirements.
Some insurance companies want complicated forms submitted by fax or mail, drawing criticism on Twitter with complaints like, "that's idiotic," and, "It's 2022, how come you guys still don't have a way to submit claims online?"
There's a cap, too. If your insurance partners with a pharmacy and you instead buy the test from a retailer, insurance will only reimburse you up to $12 per test for those purchased outside of that network.
Medicaid and children's health insurance programs are required to cover at home tests without cost-sharing, and 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.
If you need more than your monthly allotted tests, some insurers like Cigna may require medical necessity documents, as well as an attestation letter that you're not reselling the kits and need them for personal use only.
The good news is if you recently ordered free tests courtesy of Uncle Sam via the USPS, that doesn't count toward your eight tests per person, per month, allotment. Your insurance will cover the two separately, so you can stock up for the next surge.
More information: How to get your at-home OTC COVID tests for free.
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