On January 15, 2022, The Biden-Harris Administration issued a mandate requiring insurance companies and group health plans in the United States to cover the cost of at-home or over-the-counter Covid-19 tests.
That means that privately insured patients can seek reimbursement for rapid tests with no prescription or prior authorization needed.
Those uninsured or on Medicare cannot seek reimbursement but will have access to free tests through the government. The government will send you four free tests per household when you order them through covidtests.gov. You can also get free at-home tests from community health centers and Medicare-certified health clinics.
What Is an At-Home Covid-19 Test?
The at-home or over-the-counter tests, also known as rapid tests, are antigen tests. Antigen tests detect specific proteins on the virus’s surface and are used when diagnosing an active coronavirus infection.
It is best to use the test 3-5 days after you start to feel symptoms or when you know you have been exposed to someone who tested positive for Covid-19.
How To Get Reimbursed for Your At-Home Covid Test Kits in Maine
Health Insurance companies across the United States are working to implement the new requirements provided by the White House.
Health insurance providers will work as quickly as possible to implement this guidance in ways that limit consumer confusion and challenges.
Matt Eyles, president, and CEO of America’s Health Insurance Plans
Anthem Blue Cross and Blue Shield Maine
Anthem has a section in the Covid-19 Resource Center titled, Individual & Family and Employer Group Plans, listing coverage information for Covid-19 Testing.
They state that the type of plan you have will determine whether you can order an at-home test from Anthem directly.
If you want to be reimbursed for over-the-counter tests, you will need to save your receipts, log into your anthem account online and submit a claim in the Claims and Payments section.
Harvard Pilgrim Health Care
Harvard Pilgrim states that they are actively participating in the mandate to supply its members with eight over the counter Covid-19 tests per member per month.
To purchase tests with no upfront cost, they suggest visiting a Walmart or Rite Aid pharmacy.
To be reimbursed for tests you pay for out-of-pocket, you will need to submit a Member Reimbursement Form with copies of your receipt. This only applies to tests purchased after January 15, 2022.
Maine Community Health Options
Health Options has provided information regarding over the counter Covid-19 test kits by stating that if you would like to be reimbursed for a kit purchase on or after January 15, 2022, please print, fill out the At-Home Over-the-Counter (OTC) Covid-19 Test Reimbursement Form and send it through the mail. Health Options requires that a copy of the receipt and the test kit’s bar code be mailed in along with the reimbursement form.
Who Is Eligible to Receive Free Covid-19 At-Home Testing Kits?
- As of January 15, 2022, anyone with private insurance can obtain at-home test kits either for free or be reimbursed.
- MaineCare members and parents of children covered by CubCare can get free test kits at pharmacies that accept MaineCare or CubCare coverage. To learn more, visit Maine.gov/Mainecare
- As of January 19, 2022, any individual insured or not insured can order four at-home test kits per household from the federal government at no cost. To learn more, visit covidtests.gov.
Private Health Insurance Includes:
- Employer-Sponsored Health Insurance
- Affordable Care Act Marketplace Insurance
- Limited coverage or Short-Term plans
How Can I Obtain Free At-Home Covid-19 Test Kits?
You can obtain these tests by purchasing them in person through a store or online through a website. The tests covered under this requirement have been approved by the U.S. FDA, like:
- Inteliswab® COVID-19 Rapid Test kit
- BinaxNow COVID-19 Antigen Card – Self Test
- QuickVue At-Home OTC COVID-19 Test
- Ellume COVID-19 Home Test
Depending on your insurance and where you purchase the test, you will either get it free at the time of purchase or be reimbursed after submitting a claim to your plan.
For a full list of FDA-approved tests, click here.
How Many Tests Can I Purchase for Free?
Insurance companies must provide eight 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)
There is no limit to the amount of free Covid-19 tests you can take when ordered by your doctor or health care provider after an exam or online assessment. Tests ordered by a doctor or health care provider do not count towards your number of free at-home tests.
Insurance Plans & Reimbursement
The Administration is encouraging insurance companies and group health plans to set up the necessary programs to allow their clients to receive the over-the-counter or at-home tests with no out-of-pocket cost. This will eliminate the need to submit a claim for reimbursement. If someone under their coverage decides to purchase a test outside of the network, they are still required to reimburse them up to $12 per individual test.
For example: if an individual has a plan that offers direct coverage through their preferred pharmacy but that individual instead purchases tests through an online retailer outside of the network, the plan is still required to reimburse them up to $12 per individual test. (HHS.GOV)
If your plan has not set up a network of preferred stores, pharmacies, or online retailers, and you are charged for your test, you will be reimbursed for the entire amount.
Example: If you buy a two-pack of tests for $34, the plan or insurer will reimburse $24. (CMS.GOV)
If your plan requires you to pay upfront and don’t have the money, you can access free testing sites in your community. To learn where you can find community-based testing sites in Maine, click here.
If you find yourself being required to pay upfront, remember to not only hold onto your receipts but keep the boxes as well. Some insurance companies might need the barcode on the back of the packaging.
Currently, insurance companies are not required to reimburse you for test kits purchased before January 15. However, the government has given them the ability to do so. Therefore, to know for sure, it is best to contact your health plan to find out.
Yes, you can. The cost of an at-home or over-the-counter Covid test kit is an eligible medical expense. You can use your flexible spending account (FSA) or health savings account (HSA) to pay for them upfront or be reimbursed after purchase.
