February 15, 2022
The Biden Administration, in an effort to expand access to COVID-19 testing for all Americans, required private insurers and group health plans to cover the cost of at-home COVID-19 tests. The requirement meant that consumers with private healthcare coverage could easily go to a pharmacy, buy a test kit and get an upfront payment or claim reimbursement from their insurers.
From January 15, 2022, consumers covered by a group of health care plans or private health insurance who buy an over-the-counter rapid test will have those tests covered. However, the rapid tests should be authorized, cleared, or approved by the United States Food and Drug Administration (FDA) (HHS, 2022). This report will, however, focus on the COVID-19 tests reimbursement in the state of California.
The new California law went into effect on January 1, 2022, requiring insurers to fully cover the COVID-19 screening tests. Sacramento Democratic Sen. Richard Pan put forth the new bill. The bill also required that testing and vaccines be made cost-free during a future crisis. However, the program applies only to at-home COVID-19 tests purchased on or after January 15, 2022 (Perez, 2022).
As stated by the Biden Administration, insurance companies must cover eight free tests per individual per month. This, therefore, means that a family of four on the same plan would be able to access 32 test kits. Consumers of individual insurance plans can buy the rapid tests without paying anything through the direct coverage plans set out by insurers. If direct coverage is unavailable, individuals can obtain their testing kits from pharmacies or networks preferred by insurance providers.
Enrollees in plans with direct coverage can purchase rapid tests at non-preferred stores and seek reimbursement at $12 per kit. Children’s Health Insurance Program and Medicaid are also required by the emergency law to cover the cost of the over-the-counter (OTC) tests. In California, it also includes Medi-Cal plans (Lomeli, 2022).
Individuals with employer-sponsored, student health commercial insurance, and private coverage are eligible to get reimbursement for OTC COVID-19 tests. In contrast, members with Medicare, Medicaid, or voluntary insurance do not qualify for reimbursement. The tests that insurance companies reimburse are approved by the U.S FDA and are purchased on or after January 15, 2022 (Aetna, 2022).
Insurance companies like Aetna, Kaiser Permanente, and Blue Shield of California request policyholders to seek reimbursement after purchasing an at-home rapid test by filing a claim form. Other insurance companies like UnitedHealthcare choose to cover the cost at the time of purchase with the selected number of test kits providers like Walmart Pharmacy and Rite Aid. Although one can still purchase a COVID-19 rapid test at other places, insurance institutions might not fully reimburse the whole amount used as they are only required to cover up to $12 per test kit. Therefore, most of these companies advise their policyholders to purchase at their preferred networks (Lomeli, 2022).
You must submit a reimbursement form online for the at-home kits purchased outside Kaiser Permanente. You can can also download the reimbursement claim form and submit it through the mail (Kaiser, 2022).
Through the UHC insurer, an individual can get at-home test costs covered when one buys at the insurer’s preferred networks by just presenting the members’ ID at the point of purchase. If one chooses to purchase the test elsewhere, they will be required to submit a claim reimbursement form.
In cases where an individual paid the test kit provider out of pocket, the healthcare provider should make a refund after Blue Shield reimburse them. However, if the provider has not submitted a claim for you, you can submit your claim form online or mail the claim form with your receipt.
The receipt should identify the store where you purchased the kit, the date of service, the UPC for the home kit, and the test cost.
Blue Shield of California promises to cover the following plans; individual plans purchased through Blue Shield of California directly or through Covered California, Medicare supplement plan, fully-insured or Flex-funded employer-sponsored plans, and FEP HMO plans. Medicare Advantage plans and self-insured employer-sponsored plans might be covered as long as federal mandates for testing coverage.
The COVID-19 diagnostic tests covered under the Blue Shield of California include; standard PCS tests, home test kits, and rapid, point of care antigen tests (Blueshield, 2022).
COVID-19 testing should be accessible at community clinics with few exceptions at testing sites licensed in California, like major pharmacies and community testing clinics. The health insurance institutions are supposed to cover tests for their members, and the government pays for those not insured (KCRA, 2021).
Center for Disease Control and Prevention (CDC) noted that at-home tests help reduce the risk of COVID infection and exposure alongside boosters and vaccination, social distancing, and wearing masks. There is, however, no information regarding them providing at-home reimbursement.
In his bid to ensure that he expands the access to COVID-19 testing and diagnostic, President Biden required private insurance companies to cover the cost of at-home rapid tests for their members. Those that are not covered, the government will pay for them. Other states, including California, embraced the law into their system and required private insurance companies to cover the OTC tests for their members. The companies that provided the OTC test include Blue Shield of California, Aetna, UHC, and Kaiser Permanente.
These companies can reimburse the maximum amount is $12 per test kit per month. The number of tests per individual is 8 per month. Those seeking reimbursement can do so through filing a reimbursement online or sending via mail attaching the purchase receipt. The type of tests covered by insurance companies like Blue Shield of California includes standard PCS tests, home test kits, and rapid, point of care antigen tests.
Aetna. (2022). At-Home COVID-19 Self-Test Coverage & FAQs for Members | Aetna. Aetna. Retrieved January 21, 2022, from https://www.aetna.com/individualsfamilies/member-rights-resources/COVID19/otc-in-home-test-faqs.html.
Blueshield. (2022). Coverage for COVID-19 Testing | Blue Shield of CA. Blueshieldca.com. Retrieved January 21, 2022, from https://www.blueshieldca.com/bsca/bsc/wcm/connect/sites/Sites_Content_EN/coronavirus/coverage-testing.
HHS. (2022). Biden-Harris Administration Requires Insurance Companies and Group Health Plans to Cover the Cost of At-Home COVID-19 Tests, Increasing Access to Free Tests. HHS.gov. Retrieved January 21, 2022, from 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.
Kaiser. (2022). COVID-19 Testing: Schedule a Test Online | Kaiser Permanente. Healthy.kaiserpermanente.org. Retrieved January 21, 2022, from https://healthy.kaiserpermanente.org/northern-california/health-wellness/coronavirus-information/testing.
KCRA. (2021). How to get reimbursed for an at-home COVID-19 test in California. KCRA3. Retrieved January 21, 2022, from https://www.kcra.com/article/reimbursed-at-home-COVID-19-test-california/37901198#.
Lomeli, C. (2022). At-Home COVID Test Reimbursement: From Blue Shield to Kaiser, How to Get Your Health Insurance to Pay You Back | KQED. KQED. Retrieved 21 January 2022, from https://www.kqed.org/news/11902122/at-home-COVID-test-reimbursement-from-blue-shield-to-kaiser-how-to-get-your-health-insurance-to-pay-you-back.
Perez, O. (2022). New California law eliminates ‘surprise’ insurance fees for COVID-19 testing. KRON4. Retrieved January 21, 2022, from https://www.kron4.com/news/california/new-california-law-eliminates-surprise-insurance-fees-for-COVID-19-testing/.
CovidTestReimbursement.com is an informational website offering information about how to get reimbursed for your at-home Covid-19 tests.
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