Coverage by Insurance Companies and Group Health Plans of Over-the-Counter COVID-19 Tests – New Requirement Issued by Biden-Harris Administration as of January 15, 2022

As of January 15, 2022, to increase access to free testing for many Americans, the Biden-Harris Administration has required private insurance companies and group health plans to cover over-the-counter COVID-19 tests approved by the U.S. Food and Drug Administration (FDA). Consumers of over-the-counter COVID-19 tests will be paid either up front, or be reimbursed after submitting a claim to their plan. Up to 8 free over-the-counter COVID-19 tests must be covered for each covered individual per month. No clinical assessment is required for coverage of the 8 monthly over-the-counter COVID-19 tests and no shared costs will be charged to consumers (e.g., such as deductibles or a co-pay). However, there is NO limit on the number of tests that can be covered if those tests are ordered or administered by a healthcare provider following a clinical assessment.

The Biden-Harris Administration is incentivizing insurance companies and group health plans to provide the free over-the-counter COVID-19 tests via preferred pharmacies, retailers, or other entities so that consumers can purchase over-the-counter COVID-19 tests, which would be paid for at the outset by the plans, without any out-of-pocket costs charged to the consumer. If a plan does participate in such a partnership with preferred organizations, then for those over-the-counter COVID-19 tests purchased out-of-network by a consumer, a plan is required to reimburse up to $12 per test. Consumers should contact their respective plan(s) to obtain definitive guidance regarding coverage for over-the-counter COVID-19 tests.

For more information, please see these Frequently Asked Questions, https://www.cms.gov/how-to-get-your-at-home-OTC-COVID-19-test-for-free.html.

For additional details on the requirements, visit https://www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/faqs/aca-part-51.pdf

For more information on the issues relating to this article, please contact the Health Law Partners at (248) 996-8510 or (212) 734-0128 or by email at partners@thehlp.com.