In December 2021, the Biden-Harris Administration announced that they would require group health and insurance companies to cover at-home tests. Consequently, Food and Drug Administration (FDA) authorized rapid COVID-19 tests starting January 15, 2022. The policy aimed to expand access to COVID-19 testing to ease the treatment and detection process.
According to HHA, the OTC rapid tests expenses will be covered in the commercial market without individualized or providers’ clinical assessment and cost-sharing requirements. The tests will be available online or at local preferred pharmacies or retail stores. Under the emergency guidelines, insurers must cover up to eight FDA approved tests per month per individual. The law, however, does not require insurance companies to reimburse for at-home tests purchased before January 15. Still, it is suggested that you are charged for tests purchased on or after January 15 to keep their receipts for reimbursement.
For uninsured individuals, the Biden Administration purchased 500 million OTC at-home rapid tests for free to all American individuals who need them. Americans will be able to access these kits at the government website. This report, however, focuses on understanding how various insurance companies in the State of Indiana have implemented the emergency rule (Lewis & Robinson, 2022).
How To Get Reimbursement for At-Home Tests in the State of Indiana
Nefouse Health Insurance
Each enrollee has different procedures for coverage of at-home test kits; hence individual members need to check with their carrier. The company has contracted some pharmacies to distribute tests directly to the members at no cost. Each carrier will allow the member to submit a purchase receipt online from in-store retailers for those requiring reimbursement. There will be a limit of $24 per kit eligible for a refund (Nefouse, 2022).
Indiana University (IU)
Starting Saturday, January 15, 2022, IU-sponsored medical plans have been required to cover the cost of OTC, at-home COVID-19 rapid tests for enrolled members and dependents. The IU Human Resource is working with IU’s vendors like Anthem, UI Health Plans, and CVS to understand better how coverage will be applied. An individual that purchased eligible OTC COVID-19 tests on or after January 15 is required to retain their receipt or other proof of purchase to be reimbursed (Indiana University, 2022).
This coverage is available to only FDA authorized OTC, at home COVID-19 tests purchased without healthcare provider prescription. Each member is eligible for up to eight tests per month. Since the plan pays the test costs 100%, these amounts will not count towards members’ annual out-of-pocket maximum or deductibles. The reimbursement process will be provided over time (Indiana University, 2022).
The plan does not guarantee that the supply of the test will be available when or if needed due to the national shortage of the at-home tests. Further, some pharmacies may limit the number of tests an individual can buy (Indiana University, 2022).
Ambetter MHS Indiana
Beginning January 15, Ambetter members can get at-home COVID-19 testing kits at no cost. The best way to get these tests at no cost is to go to Ambetter’s in-network pharmacies. However, if a member purchases the testing kit outside Ambetter in-network retailers, they must complete a member’s reimbursement form (Ambetter, 2022).
The reimbursement will be limited to the amount of $12 per test. In addition, if the testing kit was purchased before January 15, the company will reimburse only when accompanied by a doctor or physician prescription (Ambetter, 2022).
Purchases made through Amazon or other sites can be reimbursed if a proof is provided. The company encourages members to print an image of the digital receipt or provide proof of the invoice or order number for the purchase on the reimbursement form. The maximum number of tests covered is eight in 30 days per member (Ambetter, 2022).
Aetna
New federal government guidelines allow members with the employer-sponsored, student, or individual health insurance plans to get reimbursed for OTC tests. Members can get reimbursed for OTC at-home tests, but plans like Medicaid and Medicare do not cover the same. Members are covered up to 8 OTC antigen rapid tests per month. Members can also submit a reimbursement claim on their Aetna member website or download and print out a form and mail the claim. The OTC antigen tests must be cleared and approved by the FDA. Only tests purchased on or after January 15 qualify for this reimbursement plan. Tests can be purchased online, at retail stores, or pharmacies. Members should keep their receipts (Aetna, 2022).
The success of the Biden Administration policy hinges on two factors: the availability of tests and the ability of members to navigate the direct coverage or reimbursement process. The supply of at-home tests remains limited despite the federal and state government’s efforts to increase test supply. In the early days of the policy implementation, insurance companies had varying coverage policies, including whether they should have direct coverage or request enrollees to seek reimbursement through mail or online or via fax (Dawson et al., 2022).
The Centers for Disease Control and Prevention (CDC) and the Center for Medicare and Medicaid Services (CMS) announced that payments would be available to healthcare providers and physicians to counsel patients at the time of COVID-19 testing on the importance of self-isolation after testing positive (CDC, 2020).
Additional Information
In December 2021, the US government announced group health plans and private insurers to cover at-home rapid tests authorized by the FDA beginning January 15, 2022. Accordingly, uninsured individuals have been accessing free test kits through the government website. Under insurance coverage plans, for instance, each carrier under Nefouse health insurance has different coverage procedures of at-home test kits; therefore, members should check with their carriers. In addition, members should submit a purchase receipt or other purchase proof along with the claim form. For this company, a maximum of $24 per kit will be eligible for a reimbursement. Aetna, on the other hand, provides coverage of up to eight FDA-approved tests. Members can seek reimbursement for tests purchased out of network pharmacies. The company, however, reimburses a maximum amount of $12 per test kit.
References
Aetna. (2022). At-Home COVID-19 Self-Test Coverage & FAQs for Members | Aetna. Aetna. Retrieved February 2, 2022, from https://www.aetna.com/individuals-families/member-rights-resources/COVID19/otc-in-home-test-faqs.html.
Ambetter. (2022). COVID-19 Home Testing Kits. ambetterhealth.com. Retrieved February 2, 2022, from https://www.ambetterhealth.com/coronavirus/covid-19-home-testing-kits.html
CDC. (2020). Coronavirus Disease 2019. Centers for Disease Control and Prevention. Retrieved January 18, 2022, from https://www.cdc.gov/media/releases/2020/p0730-cms-cdc-provider-reimbursement-available-COVID-19.html.
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/.
IU. (2022). Benefits Updates Related to COVID-19 | Benefits | Human Resources | Indiana University. Hr.iu.edu. Retrieved February 2, 2022, from https://hr.iu.edu/benefits/COVID19.html.
Lewis, M., & Robinson, H. (2022). Insurance companies now required to cover at-home COVID tests: What to know. fox59.com. Retrieved February 2, 2022, from https://fox59.com/news/insurance-companies-now-required-to-cover-at-home-COVID-tests-what-to-know/.
Nefouse. (2022). COVID-19 At Home Test Kits. nefousehealthinsurance. Retrieved February 2, 2022, from https://nefousehealthinsurance.com/COVID-19-at-home-test-kits/.
