Under the Coronavirus Aid, Relief and Economic Security (CARES) Act and the Families First Coronavirus Response Act (FFCRA) emergency measures passed by Congress, private insurance companies have been generally required to cover at home COVID-19 tests ordered by providers. These coverage requirements have been in place since the beginning of the pandemic, and the only exception is that these private insurers do not have to reimburse for tests conducted for the workplace or public health surveillance requirements.
The Biden Administration also provided guidance released on Jan 10, 2022, that required private insurers to cover up to eight Food and Drug Administration (FDA) authorized rapid tests per member per month. The policy, however, does not apply to Medicare advantage plans or Medicaid managed care; however, some private insurers who offer Medicare Advantage Plans may provide coverage to their members (Dawson et al., 2022).
Accordingly, this means that millions of Americans who have private health coverage plans can get the at-home tests and get reimbursed for the amount used out of pocket. Since policy implementation, insurers serving Ohio and other states have quickly implemented the federal requirement. However, the new system has proved hard to navigate to some policyholders, including consumers. These challenges include uncertainty about details of the reimbursement process, problems with insufficient supplies, and questions regarding any potential effect on data reaching local and state health departments concerning infections in their communities (Olson, 2022).
Many of the nation’s largest private insurance companies like Highmark, among others, provide paper form reimbursement options that consumers can print. Fill and mail along with a copy of the test’s box product code and a receipt. A few like Anthem, which serves 45% of privately insured individuals in Ohio, have an online submission option. This paper will discuss how private insurers provide reimbursement in Ohio State. Of note, every household in the United States is eligible to order at www.COVIDtests.gov four at-home rapid tests for free. The test is estimated to be shipped in 7 to 12 days (Kaiser Health, 2022).
How Insurers Provide Reimbursement
State Teacher Retirement System (STRS) of Ohio
Starting Jan 15, 2022, health insurers, including STRS of Ohio’s health care plan, will be required to cover up to 8 over the counter (OTC) at home COVID-19 tests within 30
day period for each non-Medicare member covered.
Express Script, the STRS Ohio Prescription Drug Program administrator, works on building systems to process tests for free at the point of sale. Until then, members obtaining the OTC test should present the Express Script ID card at the network retailer, pay the entire cost and seek reimbursement.
Steps for the Reimbursement Process
Visit any Express script preferred pharmacy and purchase eligible tests, which are; BinaxNow COVID-19 AG Self-Test, Ellume COVID-19 Home Test, FlowFlex COVID-19 AG Home Test, InteliSwab COVID-19 Rapid Test, and QuickVue At-Home COVID-19 Test.
Then purchase the eligible test at the pharmacy counter, provide your Express Script ID card at the time of purchase to enable claim processing through the prescription drug plan, retain the receipt for your records. Finally, submit the form to the address or complete the online form on the Express Script website.
Members can also submit reimbursement claims for tests acquired from other pharmacies outside the Express Script network. However, the maximum amount to be reimbursed is $12 per test kit, and the number of tests covered is 8 per month per covered person (STRS, 2022).
Ambetter
Also, beginning Jan 15, Ambetter members can get at-home COVID-19 testing kits at no cost. The best way to get these tests at no cost is to go to Ambetter’s in-network pharmacies. However, if a member purchases the testing kit outside Ambetter in-network retailers, they must complete a member’s reimbursement form. The reimbursement will be limited to the amount of $12 per test. In addition, when the testing kit was purchased before Jan 15, the company will reimburse only when accompanied by a doctor or physician prescription (Ambetter, 2022).
Purchases made through Amazon or other sites can be reimbursed if proof is provided. The company encourages members to print an image of the digital receipt or provide proof of the invoice or order number for the purchase on the reimbursement form. The maximum number of tests covered is eight in 30 days per member (Ambetter, 2022).
The Centers for Disease Control and Prevention (CDC) and the Center for Medicare and Medicaid Services (CMS) announced that payments would be available to healthcare providers and physicians to counsel patients at the time of COVID-19 testing concerning the importance of self-isolation after testing positive (CDC, 2020).
Additional Information
Under the FFCRA and CARES Acts, emergency measures passed by Congress required private insurers to cover at-home COVID-19 rapid tests ordered by providers. Also, the Biden administration required private insurance companies to provide coverage for OTC tests with no cost-sharing. The policy, however, does not apply to Medicaid and Medicare Advantage plans. STRS and Ambetter insurers cover a maximum number of eight FDA-approved tests per 30 days per member. STRS members can submit their reimbursement forms for tests purchased outside the Express Script network. The maximum amount the company can reimburse is $12 per test kit. Ambetter members can also seek reimbursement by completing a member reimbursement form. Every household in the United States is eligible to order at www.COVIDtests.gov four at-home rapid tests for free. The test is estimated to be shipped in 7 to 12 days. The success of the Biden rule is hindered by factors like the unavailability of at-home test kits when needed and the ability of members to navigate the long process of coverage and reimbursement.
References
Ambetter. (2022). COVID-19 Home Testing Kits. ambetterhealth.com. Retrieved Feb 2, 2022, from https://www.ambetterhealth.com/coronavirus/covid-19-home-testing-kits.html
Dawson, L., Amin, K., Kates, J., & Cox, C. (2022). How Are Private Insurers Covering At-Home Rapid COVID Tests?. KFF. Retrieved Feb 2, 2022, from https://www.kff.org/policy-watch/how-are-private-insurers-covering-at-home-rapid-COVID-tests/.
Kaiser Health. (2022). COVID-19 at-home tests: How are insurance companies in Ohio paying for them?. Cincinnati Enquirer. Retrieved Feb 2, 2022, from https://www.cincinnati.com/story/news/2022/01/21/COVID-19-at-home-tests-how-insurance-companies-ohio-paying-them-reimbursement-policyholders/6609288001/.
Olson, L. (2022). At-home COVID tests to be covered by insurance — but details still to come. Ohiocapitaljournal.com. Retrieved Feb 2, 2022, from https://ohiocapitaljournal.com/2021/12/03/at-home-COVID-tests-to-be-covered-by-insurance-but-details-still-to-come/.
STRS. (2022). Important Information About Free COVID-19 Tests | STRS Ohio. Strsoh.org. Retrieved Feb 2, 2022, from https://www.strsoh.org/news/2022/free-COVID-tests.html?utm_source=site&utm_medium=carousel&utm_content=article&utm_campaign=free_COVID_tests#:~:text=You%20will%20be%20reimbursed%20up,%2Dday%20period%2C%20per%20individual.
