Testing is a vital tool to help reduce the spread of the COVID-19 pandemic. Therefore, if one develops symptoms or has a known exposure to someone infected, they should be tested regardless of their vaccination status. In addition, residents should consider self-testing that can be performed anywhere or at home. Self-testing is important because it offers fast results and is more convenient than laboratory-based testing and point-of-care tests. In addition, self-tests can be used as one of many risk-reduction measures, along with masking, vaccination, and physical distancing (NKY Health, 2022).
The Biden administration directed on January 10, requiring private insurers to cover the cost of at-home tests to all covered Americans. In early February, the Biden administration also sought to fill a frustrating gap in coverage for at-home tests. The president announced that people with Medicare would get free over-the-counter rapid tests starting in early spring. The paper will discuss how private insurers in Kentucky provide coverage and reimbursement for at-home COVID-19 tests (Alonso-Zaldivar, 2022).
How To Get Reimbursement
CareSource
At-home rapid COVID-19 tests are covered as of January 15, 2022, for all members under the CareSource Marketplace plan. Members are obligated to keep their receipts and tests packaging when they purchase over-the-counter tests. The receipts will be proof of purchase because CareSourse will use them to reimburse members. The plan is yet to develop a network of locations to get at-home tests at no cost. Meanwhile, members should use the plan claim form to request reimbursement. Also, members should keep in mind that (CareSource, 2022):
- Only rapid antigen tests are covered and not PCR tests.
- They will be limited to eight at-home tests per member per month.
- At-home COVID-19 tests for employment purposes are not covered, and no prior prescription or authorization is needed to obtain rapid tests.
Western Kentucky University Employee Wellness and Benefits
As of January 15, all employees enrolled under WKU health insurance plans are covered for specific OTC at home COVID-19 tests. Moreover, the coverage plan (anthem plan) has elected to participate in a program offered through the plan’s pharmacy partners (the Know Your Rx Coalition (KYRx) and Express Script Inc (ESI)). The program allows members to obtain OTC rapid tests without out-of-pocket cost. The plan was effective on January 28, 2022. Members, therefore, can check out at the pharmacy counter, present their Anthem ID card, and the at-home tests will automatically ring up at no cost (WKU, 2022).
To find an in-network pharmacy, one is required to visit express-script.com or use their mobile app. However, if a member cannot purchase at an in-network pharmacy or have been incorrectly charged, they can submit their reimbursement receipt at ESI’s COVID-19 resource center. Members can also submit a manual claim by logging in to the Express Script account (WKU, 2022).
Moreover, if a member purchased the kits at an out-of-network pharmacy, they will be required to pay upfront and submit a request for reimbursement. The out-of-network reimbursement is capped at $12 per test. Members should attach purchase receipts when submitting reimbursement claims (WKU, 2022).
Ambetter/WellCare of Kentucky
The best way Ambetter members can acquire at-home COVID-19 tests at no cost is by going to one of Ambetter’s in-network pharmacies. However, some in-network pharmacies may require members to pay out of pocket. In that case, Ambetter will reimburse you for the cost after completing the member reimbursement form. Also, if a member decides to purchase out of network like online or from other local retailers, they will be needed to complete the claim form. The maximum amount is capped at $12 per test kit in both cases (Ambetter, 2022).
Only tests purchased on or after January 15 are covered. However, if a member purchased the kit before that date, Ambetter will reimburse when accompanied by a physician’s prescription. As a proof of purchase made online, members should print an image of the electronic receipt and send it along with the claim form. Ambetter will only cover a maximum of eight tests per member per month (Ambetter, 2022).
Anthem Blue Cross and Blue Shield of Kentucky (ABCBSKY)
Effective January 15 till the end of the public health emergency period, each individual included on your plan will be able to get up to eight OTC COVID-19 tests each month. Anthem, however, has a limited number of at-home tests available for specific members to order online. Therefore, members are encouraged to log in at anthem.com to check if their plan is eligible to receive at-home tests (BCBSKY, 2022).
Also, it is essential to note that members will be reimbursed for OTC diagnostic tests bought on or after January 15. Members will have to pay out of pocket and keep their receipt to submit a claim form online. Anthem Medicare and Medicaid members will need to visit their member website for information on their health plan covering at-home tests (BCBSKY, 2022).
Conclusion
It is imperative to note that Americans covered by Medicare this spring will be able to obtain eight at-home tests and have the cost covered by their plan. The federal and state governments have seen the significance of self-testing as it reduces the risk of exposure to the virus. With the Biden administration directive coming into effect on January 15, Kentucky insurance companies have outlined how members can obtain at-home rapid antigen tests at no cost. Anthem BCBSKY has, however, not established a network of pharmacies; therefore, their members will have to pay out of pocket and submit a reimbursement form. Insurers like Ambetter, CareSource, and WUK employees under the Anthem plan, on the other hand, have established a network of pharmacies where members can buy at-home test kits at no cost. All insurers cover a maximum of eight tests per member per month, and the amount to be reimbursed is $12 per test kit for those tests bought out of network.
References
Alonso-Zaldivar, R. (2022). Medicare opens up access to free at-home COVID-19 tests. somerset-kentucky.com. Retrieved February 9, 2022, from https://www.somerset-kentucky.com/covid-19/medicare-opens-up-access-to-free-at-home-covid-19-tests/article_ca636f90-8527-11ec-b85f-bb64fbc18930.html.
BCBSKY. (2022). COVID-19 Coverage Expanded to Include Over-the-Counter Kits for Diagnostic Tests. anthem.com. Retrieved February 9, 2022, from https://www.anthem.com/coronavirus/blog/prevention-and-getting-care/coverage-over-the-counter-kits/.
CareSource. (2022). COVID-19 Member Resource Center. Retrieved February 9, 2022, from https://www.caresource.com/ky/members/tools-resources/covid19/marketplace/.
NKY Health. (2022). COVID-19 Testing | Northern Kentucky Health Department. Northern Kentucky Health Department | We prevent disease, promote wellness and protect against health threats. Retrieved February 9, 2022, from https://nkyhealth.org/individual-or-family/health-alerts/coronavirus/covid-19-testing/.
Ambetter. (2022). COVID-19 Home Testing Kits. Ambetter.wellcareky.com. Retrieved February 9, 2022, from https://ambetter.wellcareky.com/coronavirus/covid-19-home-testing-kits.html.
WKU. (2022). Message from WKU Employee Wellness & Benefits – Over-the-Counter COVID-19 Tests. Media Relations. Retrieved February 9, 2022, from https://www.wku.edu/news/articles/index.php?view=article&articleid=10214.
