Insurers must start covering home COVID-19 testing by Jan. 15

Insurers must start covering home COVID-19 testing by Jan. 15

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Under federal guidance released Monday, health insurers must reimburse policyholders for up to eight at-home COVID-19 tests per person per month.

Insurers have until January 15 to comply. Health plans cannot impose cost-sharing or medical management tools, such as prior authorizations that limit timely testing. The guidance doesn’t apply to Medicare; Medicaid and Children’s Health Insurance plans already require free at-home coronavirus testing.

The free testing program is part of President Joe Biden’s strategy to contain the nearly two-year-old COVID-19 pandemic. Announce last month. Biden separately plans to mail 500 million home tests to U.S. households later this month.

“By requiring private health plans to cover people’s home testing, we are further expanding Americans’ ability to get a test for free when they need it,” HHS Secretary Xavier Becerra said in a statement. Press Releases.

The government encourages, but does not require, insurers to directly reimburse providers who sell tests to individuals, which will reduce costs for policyholders. This is only a partial response to criticism that having people seek reimbursement after purchasing the tests themselves would hinder access.

Under the guidance, health insurers who choose this option can limit reimbursement for tests purchased at non-preferred retailers to $12 per purchase. Health plans should notify beneficiaries if they offer direct coverage testing and what retailers are involved in, the guidance said.

“Reimbursement structures that remove barriers associated with upfront costs will facilitate access to COVID-19 testing and therefore improve health equity,” guide Say.

Programs are allowed to require proof of purchase, test written proof for personal use, or establish similar rules to address potential fraud.

Insurance companies are not happy. The Coalition for Community Health Plans believes the policy falls short of its goals, said Michael Berger, policy director for a trade group representing nonprofit insurance companies.

Instead of managing how private insurers are reimbursed, the government should focus on addressing supply chain issues that prevent people from testing at home, Bagel said. Also, he said, the federal government should shoulder the cost, not health plans.

“In addition to all the other services we have for COVID (the continued increase in treatment, the increasing number of hospitalizations), home testing is just another unfunded task,” Bagel said. The consequences will be higher, he said. Expenses, and then premium increases.

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