Starting January 15th, 2022, health insurers and issuers will have to cover at-home or over-the-counter (OTC) COVID-19 tests that individuals can use to test themselves for the virus.
Various parties have already raised several questions and concerns, as insurers may now face high up-front costs.
The federal government has tried to answer some of these questions through its recently issued guidance on OTC COVID test coverage requirements.
Here's the gist of it:
Mandatory coverage for COVID-19 tests will apply only as long as the emergency lasts.
The coverage period required insurers to cover COVID-19 tests without cost-sharing requirements, prior authorization, or other related conditions.
Initially, the tests were not covered unless a healthcare provider determined that a patient needed the test, mainly because the FDA had not yet approved any at-home test and self-diagnosis.
As of January 15th, 2022, various tests have been approved, which must be covered by the insurance provider, regardless of a healthcare provider's involvement.
Employers don't have to worry about this guidance - coverage is not required UNLESS for individual purposes.
Insurers may decide to grant coverage to individuals upon purchasing a test and claiming reimbursements rather than to cover sellers directly.
Insurers may pay only the actual cost of the test or $12, whichever is lower.