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.

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