As part of its continued endeavor to improve Americans’ access to free testing, the Biden-Harris Administration issued a mandate to insurance companies and group health plans to cover the cost of over-the-counter, at-home COVID-19 tests beginning January 15, 2022.
The new regulation will allow most consumers with private health insurance to purchase tests online or in-person and have the money paid for upfront by their health plan or reimbursed by claiming reimbursement.
The intention is that insurance companies will be compelled to cover the price of the tests upfront without the need to file a reimbursement claim, making getting an at-home test easier.
According to the new mandate, insurance companies and health plans must provide up to 8 free at-home tests per person per month.
Example: A family of four, all on the same plan, would be able to get up to 32 of these tests covered by their health plan per month. (HHS.GOV)
What Is an At-Home Covid-19 Test?
An at-home Covid-19 test, also known as a rapid test, OTC (over the counter), or antigen test, is designed to identify specific proteins on the virus’s surface and is used to diagnose an active coronavirus infection.
The insurance companies are covering these tests for diagnostic purposes only. Meaning, If you have come into touch with someone or are experiencing symptoms of Covid-19, it is advised to isolate at home and wait 3-5 days before taking the test to ensure the virus is found.
How to Get Reimbursed for Your At-Home Covid Test Kits in Wisconsin
Anthem Blue Cross Blue Shield
Anthem’s FAQ page for at-home Covid-19 tests states that they have a limited number of at-home diagnostic test kits available. Therefore, the members recommend logging in using the SydneySM Health mobile app or anthem.com to determine if they are eligible. If you qualify, you will see the option to order a test kit. If you are not eligible, you will not see that option.
Members who cannot purchase directly from Anthem can be reimbursed by submitting a claim online. To submit a claim, you will need to log into your account on the website, go to Claims & Payment and select Submit a Claim.
If you have an Anthem Medicaid or Medicare plan, you will need to visit your member website for information on how you can receive free Covid-19 testing.
Common Ground Healthcare Cooperative
Common Ground has a Covid-19 resource document stating that they offer their members at-home Covid-19 test with no upfront cost when you visit an in-network pharmacy and purchase an FDA-approved test kit at the pharmacy counter. The following pharmacies are in-network:
- Kinney Drugs
- Rite Aid Pharmacy (including Bartell Drugs)
- Sam’s Club Pharmacy
- Walgreens Pharmacy
- Walmart Pharmacy
If you purchase an FDA-approved at-home test somewhere else, you can file a claim through OptumRX and receive a reimbursement for up to $12 per test. To learn more about that, click here.
Once your reimbursement is processed, OptumRx will issue a check to the qualifying member. The whole process may take up to 30 days.
Medica
Medica states on their Individual and Family Plan Covid-19 FAQ that Medica members enrolled in individual plans and commercial fully and self-funded plans have coverage for eight at-home COVID-19 antigen tests without a prescription from a qualified health professional.
To receive these free tests, you need to visit an in-network pharmacy and purchase the tests at the pharmacy counter
If you purchase an FDA-approved test at the front of the store or a location not in-network, you will need to pay for the test and submit a reimbursement claim. You will be reimbursed up to $12 per test purchased on or after January 15, 2022.
Security Health Plan
Security Health Plan’s Covid-19 testing resource page states that members can get at-home Covid-19 tests with no upfront costs through in-network pharmacies. To find a participating pharmacy, click here.
If you purchase an FDA-approved test through a different process, you can get up to $12 reimbursed per test by filling out the correct reimbursement form:
- When purchased at an out-of-network pharmacy, download the MedImpact Commercial Prescription Drugs Claim Form.
- When purchased at a non-pharmacy location, download the Security Health Plan Member Covid-19 Over-the-Counter Testing Reimbursement Form.
Additional Important Information
Wisconsin offers its citizens free at-home Covid-19 tests through the Wisconsin Department of Health Services. Click here to learn more.
The government launched a website on January 19, 2022, where you can sign up to receive four free at-home test kits per household and receive them through the USPS.
For a full list of FDA-approved at-home testing kits, click here.
You can also get free at-home tests from community health centers and Medicare-certified health clinics.
Resources:
Hyperlinks used in the article:
- https://www.hhs.gov/about/news/2022/01/10/biden-harris-administration-requires-insurance-companies-group-health-plans-to-cover-cost-at-home-covid-19-tests-increasing-access-free-tests.html
- https://www.hhs.gov/about/news/2022/01/10/biden-harris-administration-requires-insurance-companies-group-health-plans-to-cover-cost-at-home-covid-19-tests-increasing-access-free-tests.html
- https://www.anthem.com/coronavirus/blog/prevention-and-getting-care/coverage-over-the-counter-kits/
- https://www.anthem.com/
- https://www.anthem.com/login/
- https://commongroundhealthcare.org/wp-content/uploads/2022/02/COVID-At-Home-Test-Kit-FAQ-2022-0210.pdf
- https://covidtest.optumrx.com/covid-test-reimbursement
- https://www.optumrx.com/content/rxmember/default/en_us/angular-free/optumrx/Information-Center/test-reimbursement.html?is=orxrd:orx:covidtest
- https://www.medica.com/shop/individual-and-family/individual-and-family-faq/individual-and-family-covid-faqs
- https://www.medica.com/-/media/Documents/Pharmacy/Shared/Prescription-Reimbursement-Claim-Form-Express-Scripts.pdf
- https://www.securityhealth.org/covid19/covid-19-testing
- http://openenrollment.medimpact.com/#/plancode?SEC022020PL
- https://www.securityhealth.org/-/media/Member/M—Member-Prescription-Drug-Reimbursement-Form.pdf?la=en&hash=F7C5E27013DB79D57F64C8C30D15BB11&hash=F7C5E27013DB79D57F64C8C30D15BB11
- https://www.securityhealth.org/-/media/Member/COVID-Test-Reimbursement-form.pdf?la=en&hash=431F768F175C9BAEDE841CB9B7538B67
- https://www.dhs.wisconsin.gov/covid-19/testing.htm
- https://www.covidtests.gov/
- https://www.fda.gov/medical-devices/coronavirus-disease-2019-covid-19-emergency-use-authorizations-medical-devices/in-vitro-diagnostics-euas
- https://www.hrsa.gov/coronavirus/testing-supplies
