WASHINGTON — Private insurers will soon have to cover the cost of eight at-home coronavirus tests per member per month, the Biden administration said Monday.
People will be able to get the tests at their health plan’s “preferred” pharmacies and other retailers with no out-of-pocket costs, according to the Department of Health and Human Services. They can also buy the test elsewhere and file claims for reimbursement. This is similar to what they do for their medical care.
“Today’s action further removes financial barriers and expands access to Covid-19 tests for millions of people,” Chiquita Brooks-LaSure, the Biden administration’s Medicare and Medicaid chief, said in a statement about the new guidelines.
About 150 million Americans are privately insured, which is approximately 45 percent of the country’s population. Each dependent who is enrolled in primary insurance counts as a member.
At out-of-network facilities, insurers’ responsibility would be capped at $12 per test, meaning people could be responsible for any additional costs.
But if a health plan does not establish a network of “preferred” retailers where patients can get tests covered upfront, it will be responsible for whatever claims its patients submit for their eight monthly rapid tests, with no limit on the price.
Sabrina Corlette a research professor at Georgetown University’s Center on Health Insurance Reforms, said the policy could save families hundreds of dollars a month.
“I would love to see a more comprehensive national testing policy where these tests are free for everybody, regardless of insurance status,” she said. “Will it help everybody? No. It is not the best way to lower barriers to Covid test. But it is helpful.”
Rapid at-home testing is typically sold in packs, with prices ranging from $14 to $34. This can be prohibitively costly, especially if you buy tests in bulk.
Other countries have invested more in rapid testing. Citizens in Britain can order free rapid tests from a government website. Germany invested hundreds of million of dollars to establish a network with 15,000 rapid testing centers. Instead, the United States has focused its public purchasing on vaccines and efforts to encourage their adoption.
To combat the latest wave, some local governments have invested heavily into rapid testing. Residents of Washington, D.C., who have seen a significant rise in virus cases, are now able to receive four free rapid testing at their local libraries each day.
The new Biden policy does not retroactively apply to at-home testing that Americans have already purchased. Tests ordered or administered by health providers will continue to be covered by insurance without any co-payment or deductible under a law requiring insurers to fully cover tests at doctor’s offices, public sites and other facilities.
The administration is also working on other ways to get coronavirus test results to everyone regardless of insurance status. For example, a plan that will deliver 500 million free rapid tests directly to the homes of Americans who request them, and it will be available later this month.
This plan, along with new rules for insurers, was part of a larger effort by the Biden administration to meet the increasing demand for rapid tests as virus cases have increased dramatically in the United States since the Omicron variant of the Omicron virus arrived.
The administration also announced plans for tens of million of free tests to be made available to uninsured Americans at clinics and other locations in underserved areas. It recently opened federally managed test sites in difficult-hit regions of America.
Matt Eyles, president of the health insurer trade group America’s Health Insurance Plans, said in a statement that insurance companies would “work as quickly as possible to implement this guidance.”
“While there will likely be some hiccups in early days, we will work with the administration to swiftly address issues as they arise,” he said.
Omicron descended and supplies at grocery and pharmacy stores for the tests almost dried up. Manufacturers are now racing to stock shelves. This scramble has led some experts to criticize Omicron’s administration for being caught flat-footed.
Low availability could hamper the rollout, according to Lindsey Dawson, a Kaiser Family Foundation policy analyst who has studied the availability of rapid tests.
“If reimbursement exists but there aren’t tests to purchase,” she said, “that doesn’t help an individual consumer.”
She added, “The policy could certainly drive demand, and could exacerbate the problem.”
Ms. Dawson indicated that prices have been rising at major retailers such as Walmart. She said that this could lead to significant upfront costs for families filing claims for reimbursement.
The Coronavirus Pandemic – Key Facts to Know
Some health plans expressed concern about the possible shortage of supply if the policy is not out within a week.
“We are concerned that the policy does not solve for the limited supply of tests in the country and could cause additional consumer friction as insurers stand up a program in just four days’ time,” Kim Keck, the chief executive of the Blue Cross Blue Shield Association.
The Georgetown researcher Ms. Corlette pointed out several other problems with the new policy. The guidance does not specify how insurers should design reimbursement programs. This could lead to more complicated processes with less user-friendly websites, and more hoops to jump through. There is no deadline for reimbursement.
She also stated that the policy will only be in place for the duration the Covid-19 public emergency.
On Sunday, dozens upon democrats wrote to President Biden urging him to expand access and make it possible for everyone to take one every week. They also warned that insurance reimbursement could be slow and discourage people from purchasing tests.
In December, Mr. Biden announced his reimbursement plan. Some public health experts expressed doubts about his claims. They wondered why the United States wasn’t buying tests in bulk, offering them for little to no cost, like European countries.
Jen Psaki was the White House press secretary and dismissed the idea of an extensive program to provide free testing to Americans.
But as the administration faced intensifying criticism, Mr. Biden announced that his administration would offer 500 million free at-home tests for the nation’s 330 million residents, available to order through a website that is supposed to debut this month.
A White House official stated that there will be a hotline that people will be able to call if they don’t have access to computers or prefer ordering tests by phone.
The administration is racing against the clock to sign a series test contracts with companies in possession of tests or manufacturers; the first two were announced last Friday.
Officials said that more agreements will be announced over the coming days. Biden administration officials said they are careful not appropriate tests that have been delivered to Walgreens or CVS.
It is unclear how many tests each household will have the ability to order through the program and what brands they will be able purchase. The F.D.A. More than a dozen antigen tests at home have been authorized by the F.D.A., some under a new accelerated program announced last year.
The success of the administration’s efforts to get more tests to Americans could also be complicated by preliminary research suggesting that rapid antigen tests may miss some Omicron infections even when people are carrying high levels of the virus. Scientists warn that negative results can be misinterpreted by people who have symptoms or have been exposed to the virus. Experts continue to recommend the use of the tests.
Source: NY Times