The Biden administration announced on December 2, 2021, followed by a detailed guideline, released on January 10, 2022, that private insurance companies will be required to cover the cost of at-home rapid COVID-19 tests purchased over the counter (OTC), beginning January 15, 2022.
Under the new emergency rule, private insurers must cover up to eight Food and Drug (FDA) approved tests per month per member. This policy only applies to private insurers and not Medicare Advantage or Medicaid-managed care plans. In addition to providing reimbursement for at-home tests purchased out of pocket, the rule also encourages those companies to establish direct coverage options (White House, 2022)
Members in plans with direct coverage can seek reimbursement for at-home test kits bought at non-preferred stores, but the guideline only allows private insurers to cap reimbursement at $12 per test kit. Although Medicare does not cover the at-home test kit cost, Medicare Advantage Plans offered by private insurers have the option of covering OTC tests (Freed & Cubanski, 2022). This report will discuss COVID-19 test reimbursement in Florida state.
How To Get Reimbursed from Health Care Insurance Providers in Florida
Blue Cross and Blue Shield Association
Starting January 15, 2022, the company will reimburse members for purchasing at-home COVID-19 diagnostic tests approved and authorized by the United States (U.S.) FDA. The OTC tests can be purchased online or at local retailers. The type of test must be cleared, approved, and authorized by the US FDA, including IntlSwab COVID-19 Rapid Test Rx, SCoV-2 Ag Detect Rapid Self-Test, and BinaxNOW COVID-19 Ag Card Home test, among others (Blue Cross and Blue Shield Association, 2022).
Plan members will be required to pay out of pocket and file for reimbursement. The reimbursement process involves; saving the purchase receipt and cutting out the UPC Code on the test box, downloading and printing the reimbursement form, and mailing the form along with the receipt and UPCs to the address on the form (Blue Cross and Blue Shield Association, 2022).
The processing standard for claims is in 30 days. The status of members’ claims can be viewed by logging in to My Health Toolkit. The reimbursement is sent in the form of a check. Blue Cross and Blue Shield Association will also reimburse other expenses, including shipping and sales tax. Therefore members are encouraged to include them with their documentation. The company does not cover OTC tests bought before January 15, and members do not need a doctor’s prescription to qualify for a covered OTC test (Blue Cross and Blue Shield Association, 2022).
The Blue Cross and Blue Shield Associationwill only provide reimbursement for up to 8 tests per 30-day period for every individual covered under the plan. In addition, members that need tests to comply with workplace requirements can take advantage of free testing in their communities as the plan does not cover such costs. Individuals that cannot afford upfront costs can also visit their community clinics for free testing (Blue Cross and Blue Shield Association, 2022).
GuideWell (Florida Blue)
The Florida Blue has a direct coverage option. Therefore, members can purchase at-home rapid tests at preferred or in-network pharmacies with no up-front cost. Enrollees under the plan can also seek reimbursement for OTC rapid tests purchased from network retailers, typically by mail and attaching purchase receipts (Cerullo, 2022). The process involves locating the form at the health plan website, printing it out, filling and sending it. However, the company can reimburse members for a maximum of $12, and members will pay any additional cost out of pocket (Miller, 2022).
With the high demand for over-the-counter COVID-19 rapid tests, virus testing and screening shortage persist. Therefore, consumers will have to toggle between physical and online retailers to find tests in stock. In addition, preferred pharmacies may not have them on physical or virtual selves forcing members to go the long reimbursement route. Finally, the Biden rule applies to private insurance companies; uninsured people will have to navigate the different options, including ordering COVID-19 tests from the government directly or visiting their local health clinics to get tested (Dawson et al., 2022).
The Biden-Harris Administration also took new actions, including making tests available to schools nationwide to increase access to coronavirus testing. Schools will be given 10 million tests per month to help the school remain safely open. In addition, the government supports free testing access to school staff, families, and students through federal testing sites. Other actions include increasing the number of authorized tests increasing the number of places to get tested, among others (White House, 2022).
Additional Information
The Biden Administration guidance released on January 10 required that private insurers provide coverage for at-home rapid tests purchased over the counter beginning January 15. Under the new rule, private insurers must cover up to eight FDA-approved tests per month per member. Members can also seek reimbursement for tests purchased out of network, and the maximum amount to be reimbursed is $12. Insurance companies like Blue Cross Blue Shield Association and GuideWell provide coverage for at-home COVID-19 tests. Members should attach a copy of the receipt and UPC as proof for purchase. Other actions taken by the administration to increase access to COVID-19 testing include increasing the number of authorized tests and the number of places to get tested. The types of tests covered include IntlSwab COVID-19 Rapid Test Rx, SCoV-2 Ag Detect Rapid Self-Test, and BinaxNOW COVID-19 Ag Card Home test, among others.
References
Blue Cross and Blue Shield Association. (2022). Coverage for Over-the-Counter Tests. Myhealthtoolkit. Retrieved February 2, 2022, from
Cerullo, M. (2022). Is your insurer supplying home COVID-19 tests at no upfront cost? Cbsnews.com. Retrieved February 2, 2022, from https://www.cbsnews.com/news/COVID-19-test-free-insurance-no-upfront-cost/.
Dawson, L., Amin, K., Kates, J., & Cox, C. (2022). How Are Private Insurers Covering At-Home Rapid COVID Tests? KFF. Retrieved February 2, 2022, from https://www.kff.org/policy-watch/how-are-private-insurers-covering-at-home-rapid-COVID-tests/.
Freed, M., & Cubanski, J. (2022). Are Medicare Advantage Insurers Covering the Cost of At-Home COVID-19 Tests? KFF. Retrieved February 2, 2022, from https://www.kff.org/policy-watch/are-medicare-advantage-insurers-covering-the-cost-of-at-home-COVID-19-tests/.
Miller, K. (2022). How to Get Reimbursed for Your At-Home COVID Test by Your Insurance Company. Health.com. Retrieved February 2, 2022, from https://www.health.com/condition/infectious-diseases/coronavirus/how-to-submit-at-home-COVID-test-to-insurance.
White House. (2022). Fact Sheet: The Biden Administration to Begin Distributing At-Home, Rapid COVID-19 Tests to Americans for Free | The White House. The White House. Retrieved February 2, 2022, from https://www.whitehouse.gov/briefing-room/statements-releases/2022/01/14/fact-sheet-the-biden-administration-to-begin-distributing-at-home-rapid-COVID-19-tests-to-americans-for-free/.
