To curb the spread of Covid-19 in the United States and to improve access to free testing, the Biden-Harris Administration released a mandate stating that starting January 15, 2022,
“Individuals with private health insurance coverage or covered by a group health plan who purchase an over-the-counter COVID-19 diagnostic test authorized, cleared, or approved by the U.S. Food and Drug Administration (FDA) will be able to have those test costs covered by their plan or insurance. Insurance companies and health plans are required to cover 8 free over-the-counter at-home tests per covered individual 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), and antigen test, are created to detect specific proteins on the virus’s surface and are used when diagnosing an active coronavirus infection.
If you have come into contact with someone or are showing symptoms of Covid-19, it is best to quarantine at home and wait 3-5 days before taking the test to ensure the virus will be detected.
How to Get Reimbursed for Your At-Home Covid Test Kits in New Jersey
All health care companies in the United States are working to provide information to their members to comply with the new mandate.
“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
AmeriHealth
In their Covid-19 resource page, AmeriHealth NJ states that it will cover up to eight at-home tests per month.
If you have FutureScripts (OptumRx) coverage, you can purchase an FDA-approved test kit through any Walmart, Sam’s Club, or Rite Aid for free. To do so, you must present your member ID card and state that you will need to have the OTC test submitted to OptumRx. You can also visit the Optum Store to purchase them online for free.
If you choose to purchase an FDA-approved test kit outside of the locations listed above, you can still be reimbursed afterward for up to $12 per test. However, the purchase will have to be made on or after January 15, 2022. To submit your reimbursement, complete the OptumRx Over-the-Counter Test Reimbursement Form and include your receipts. If you submit claims for more than one family member, you will need to submit a separate claim for each one.
AmeriHealth NJ covers the cost for medically appropriate diagnostic and antibody testing of COVID ordered by an authorized health care professional at no cost to the member. AmeriHealth NJ does not cover tests needed for return to work, a condition of employment, return to school or travel.
Horizon Blue Cross Blue Shield of New Jersey
Horizon’s Covid-19 Testing resource page states that beginning January 15, 2022, they will cover at-home covid-19 testing kits through their member’s pharmacy benefits. Members can receive these free testing kits through one of their participating pharmacies. To find a participating pharmacy, click here.
To have your testing kit covered, you must go to the pharmacy counter and show your Horizon NJ Health member ID card. The kits will be processed as part of your Pharmacy benefit.
If you buy a test from a pharmacy or store outside of the network, you will need to submit a pharmacy claim form to Prime Therapeutics LLC for reimbursement. You will be reimbursed for up to $12 per test.
Horizon states on their website that they will only allow free tests to be purchased for diagnostic testing and not for surveillance testing.
Additional Important Information
Along with the new mandate requiring insurance companies to give free at-home test kits or to reimburse their members, the government has also launched a website where every citizen can order four free tests per household.
The state of New Jersey also offers residents one free test per resident shipped directly to their address. To learn more, click here.
You can also get free at-home tests from community health centers and Medicare-certified health clinics.
If you already bought a test and are looking to have them reimbursed, the following are covered by insurance:
- BinaxNOW COVID-19 Antigen Self-Test
- CareStart COVID-19 Antigen Home Test
- Flowflex COVID-19 AG Test
- Flowflex COVID-19 Antigen Test
- InteliSwab COVID-19 Rapid Test
- QuickVue At-Home COVID-19 Test
For a full list of FDA-approved tests, click here.
Resources:
- 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
- COVID-19 | AmeriHealth New Jersey (amerihealthnj.com)
- Covid19 FAQs | AmeriHealth New Jersey (amerihealthnj.com)
- Department of Health | Communicable Disease Service | COVID-19 (nj.gov)
- At-Home COVID-19 Testing – Horizon NJ Health
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.ahip.org/ahip-comments-on-administrations-guidance-for-covering-over-the-counter-covid-19-tests/
- https://www.amerihealthnj.com/html/custom/covid-19/index.html
- https://store.optum.com/
- https://covidtest.optumrx.com/covid-test-reimbursement
- https://covidtest.optumrx.com/covid-test-reimbursement
- https://www.horizonnjhealth.com/membersupport/updates-and-announcements/home-covid-19-testing
- https://www.horizonnjhealth.com/findadoctor
- https://www.horizonblue.com/sites/default/files/2020-06/RxReimbursement_Claim_Form_4.pdf
- https://www.covidtests.gov/
- https://covid19.nj.gov/faqs/nj-information/testing-and-treatment/how-do-i-get-a-free-at-home-covid-19-saliva-test?utm_campaign=20211229_nwsltr&utm_medium=email&utm_source=govdelivery
- https://www.hrsa.gov/coronavirus/testing-supplies
- https://www.msn.com/en-us/news/other/health-insurers-must-pay-for-your-at-home-covid-tests-as-of-jan-15-e2-80-94heres-how-to-get-reimbursed/ar-AASKsjh?ocid=uxbndlbing
