Insurers must begin covering at-home COVID-19 tests by Jan. 15

MAYA GOLDMAN / January 10, 2022

Health insurance companies must reimburse policyholders for up to eight at-home COVID-19 tests per person each month under federal guidance published Monday.

Insurers must comply by Jan. 15. Health plans can't impose cost sharing or medical management tools such as prior authorization that would limit timely access to tests. The guidance doesn't apply to Medicare; Medicaid and the Children's Health Insurance Plan already require no-cost at-home coronavirus tests.

The free testing initiative is part of President Joe Biden's strategy to contain the nearly two-year-old COVID-19 pandemic, which he announced last month. Biden separately plans to mail 500 million at-home tests to U.S. households later this month.

"By requiring private health plans to cover people's at-home tests, we are further expanding Americans' ability to get tests for free when they need them," Health and Human Services Secretary Xavier Becerra said in a news release.

The government encourages but doesn't require insurance carriers to directly reimburse vendors that sell tests to individuals, which would reduce policyholders' costs. This only partly answers criticisms that making people seeking reimbursement after buying tests on their own would hamper access.

Health insurance companies that elect that option are allowed to cap reimbursement for tests purchased at non-preferred retailers to $12 per purchase, according to the guidance. Health plans should notify beneficiaries if they offer direct coverage of tests and what retailers are participating, the guidance says.