WASHINGTON (NYTIMES) – Private insurers will have to cover the cost of eight at-home coronavirus tests per member per month starting Saturday (Jan 15), the Biden administration said Monday.
People who provide their insurance information will be able to get the tests with no out-of-pocket costs at certain pharmacies; in other cases, they will have to file claims to their insurers for reimbursement, according to the Department of Health and Human Services, just as they often do for medical services.
The plan “incentivises insurers to cover these costs upfront and ensures individuals do not need an order from their health care provider to access these tests for free,” the agency said in a statement.
Roughly 150 million Americans, or about 45 per cent of the population, are privately insured.
Insurers that do not require people to pay the upfront cost for tests at certain retailers will be charged no more than US$12 (S$16.30) per test, if the test was purchased at an out-of-network site. Otherwise, insurers will be charged the full price of a test.
“Today’s action further removes financial barriers and expands access to Covid-19 tests for millions of people,” Ms Chiquita Brooks-LaSure, the Biden administration’s Medicare and Medicaid chief, said in a statement.
The at-home tests are typically sold in packs of two, and prices have ranged in cost from US$14 to US$34, which can be prohibitively expensive especially when tests are purchased in bulk.
Tests ordered or administered by a health provider would continue to be covered by insurance without co-payment or a deductible, the administration said.
Other countries have spent more heavily on rapid testing. In Britain, citizens can use a government website to order free rapid tests for home use. Germany invested hundreds of millions of dollars to create a network of 15,000 rapid-testing sites.
The United States has instead focused public purchasing on vaccines and efforts to encourage their uptake.
Some local governments in the United States have invested more heavily in rapid testing to counter this latest wave of cases. Washington DC, for example, now allows residents to pick up four free rapid tests daily at eight libraries across the city.
The new US policy does not apply to at-home tests that Americans have already purchased.
The Biden administration is also working on other efforts to get tests to people regardless of their insurance status, including a plan to deliver 500 million free rapid tests to the homes of Americans who order them, starting later this month.
Like that plan, the guidelines announced Monday were part of a broader effort the Biden administration has undertaken in recent weeks to catch up to skyrocketing demand for rapid tests, as virus cases have exploded around the nation with the arrival of the highly contagious Omicron variant.
Supplies of the tests at pharmacies and grocery stores quickly diminished last month, and manufacturers are racing to restock shelves, a scramble that has prompted some experts to criticise the administration for being caught flat-footed ahead of a winter surge.
Availability could at first hinder the rollout of the reimbursement policy, said Ms Lindsey Dawson, an associate director at the Kaiser Family Foundation who has researched 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.”