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Does My Insurance Cover Over-the-Counter (OTC) COVID-19 Tests?

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:


  1. Mandatory coverage for COVID-19 tests will apply only as long as the emergency lasts.

  2. The coverage period required insurers to cover COVID-19 tests without cost-sharing requirements, prior authorization, or other related conditions.

  3. 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.

  4. 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.

  5. Employers don't have to worry about this guidance - coverage is not required UNLESS for individual purposes.

  6. Insurers may decide to grant coverage to individuals upon purchasing a test and claiming reimbursements rather than to cover sellers directly.

  7. Insurers may pay only the actual cost of the test or $12, whichever is lower.


NY Small Health works with companies like Aetna and UnitedHealthCare, which, coincidentally, offer coverage for at-home tests.


Stay in the loop about health insurance updates and small business health benefits packages by visiting NYSmallhealth.com or contacting a friendly professional.


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