Home COVID-19 Test Kits Covered by Health Insurance

Earlier this week (January 10, 2022) the White House announced a requirement that most private health insurance payers must cover the cost of home COVID-19 test kits, starting January 15, 2022.  The new benefit waives any plan related cost sharing (e.g., copay/deductible/coinsurance) for the purchase of a limited supply of physician prescribed home test kits.  Here are some of the pertinent details regarding this new health insurance benefit –

• – Health Insurance Payers (e.g., insurers, third party administrators, employers) have two compliance options – 1. Direct reimbursement at the point of purchase, to certain/select vendors that sell test kits; or 2. A reimbursement process whereby eligible/covered members would need to seek reimbursement from their health insurer.
• – Payers that opt to contract with certain vendors (e.g., online retailers, pharmacies, stores) for the test kits can limit the reimbursement amount to $12/kit if purchased by a non-contracted vendor.  There is no benefit price cap on test kits if a payer utilizes the reimbursement method.
• – The requirement allows up to 8 test kits per family member, per month, subject to a doctor’s order or prescription.
• – The requirement is NOT retroactive, so only qualified kits purchased on or after January 15, 2022 are eligible for the benefit.
• – COVID-19 testing that is done outside of the home (e.g., PCR, Antigen/rapid test) continues to be covered in full by private insurance, for the duration of the national state of emergency.
• – In addition to insurer covered testing, the federal government plans to make 500 million test kits available via a website, and delivered through the mail, at no cost.  The website and home delivery are expected to be available later this month (January, 2022).
• – Both Medicaid and the Children’s Health Insurance Program (CHIP) already provided no cost, home testing kits.  Traditional Medicare plans are not required to provide home testing kits as of the published date of this blog post; and Medicare Advantage (also known as Part C) members are urged to contact their health insurer to see if home testing kits are covered.

With such a short window of time for compliance, expect some communication and fulfillment delays, associated with this new benefit. Some payers may start out using the reimbursement method, and subsequently pivot to the direct/point of purchase reimbursement method, once the necessary arrangements with vendors are put in place.

The home test kit insurance cost share waiver benefit will likely expire at some point, once the national state of emergency comes to a conclusion.

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