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Insurers are supposed to pay for COVID-19 tests starting Jan. 15. So why are so many confused?

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By Elisabeth Buchwald

Jan. 15 marks the first day that private health insurance companies will be required to reimburse policyholders for at-home COVID-19 tests they purchase, according to guidance the Biden administration published on Monday.

However, insurance companies may not have their systems up and running by then to comply with the new guidance, which was originally announced in early December but only finalized recently.

The guidance requires private insurers to cover eight rapid COVID-19 tests a month by either setting up a network of retailers so that policyholders don’t have to pay anything upfront for tests, or enabling consumers to submit receipts for reimbursement.

If the policyholder purchases a test from a retailer that is out-of-network, insurers are only required to pay up to $12 per test.

When MarketWatch reached out to several of the largest private health insurance companies — including Kaiser Permanente, Aetna /zigman2/quotes/209664499/composite CVS +0.91% , UnitedHealth Group /zigman2/quotes/210453738/composite UNH +0.53% , Anthem /zigman2/quotes/203808743/composite ANTM +0.36% and Cigna /zigman2/quotes/208431372/composite CI +1.62% — they couldn’t provide any details on how consumers could start getting reimbursed for tests beginning Jan. 15.

“Access to testing has been a critical component of our pandemic response. We are reviewing the guidance and plan to adjust our coverage policies as appropriate,” Ethan Slavin, an Aetna spokesperson, told MarketWatch.

“We are reviewing the Biden Administration’s recent guidance on reimbursement for at-home COVID-19 tests,” said Marc Brown, a spokesperson for KaiserPermanente. “We’re working to make these tests available at no cost to our members through multiple outlets.” 

UnitedHealth declined to comment. Cigna and Anthem didn’t respond to requests for comment.

“Plans and insurers are working rapidly to determine how they will cover or reimburse over-the-counter COVID-19 tests, and may not be able to answer questions until after January 15,” a spokeswoman for the Centers for Medicare & Medicaid Services told MarketWatch.

“If a consumer is charged for a test, the individual should keep their receipt and submit a claim to their health plan for reimbursement,” the spokeswoman added. “Consumers can find out directly from their plans how to submit reimbursement claims. Plans are not allowed to design their reimbursement process in a way that unduly delays reimbursement to a consumer.”

If you are covered by state Medicaid or Children’s Health Insurance Program (CHIP) programs, you are entitled to get at-home COVID tests without cost-sharing.

But if you are uninsured or are covered by Medicare, you can receive free tests through a forthcoming federal website or from some local community centers and pharmacies.

/zigman2/quotes/209664499/composite
US : U.S.: NYSE
$ 99.45
+0.90 +0.91%
Volume: 1.92M
May 17, 2022 12:59p
P/E Ratio
16.47
Dividend Yield
2.22%
Market Cap
$129.23 billion
Rev. per Employee
$999,037
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/zigman2/quotes/210453738/composite
US : U.S.: NYSE
$ 491.82
+2.60 +0.53%
Volume: 900,931
May 17, 2022 12:59p
P/E Ratio
26.90
Dividend Yield
1.18%
Market Cap
$458.97 billion
Rev. per Employee
$850,143
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/zigman2/quotes/203808743/composite
US : U.S.: NYSE
$ 495.36
+1.77 +0.36%
Volume: 309,778
May 17, 2022 12:59p
P/E Ratio
19.52
Dividend Yield
1.03%
Market Cap
$119.00 billion
Rev. per Employee
$1.47M
loading...
/zigman2/quotes/208431372/composite
US : U.S.: NYSE
$ 270.81
+4.32 +1.62%
Volume: 589,571
May 17, 2022 12:59p
P/E Ratio
16.75
Dividend Yield
1.66%
Market Cap
$84.84 billion
Rev. per Employee
$2.40M
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