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Cost and Availability of At-Home COVID-19 Tests – Impact on Employers and Employees

Cost and Availability of At-Home COVID-19 Tests – Impact on Employers and Employees

Jan 24, 2022, 3 Minute Read

The federal government recently introduced two initiatives regarding the cost and availability of at-home COVID-19 tests. You may be getting questions from your clients. To help you, we’ve put together a summary of the impact on employers and employees:

Firstly, the federal government has launched a website – covidtests.gov – where at-home COVID-19 tests can be ordered. These tests are provided free of charge by the federal government. There’s a limit of four tests per household. Tests are expected to ship 7-10 days from the order date. Health insurance companies and group health plans are not involved or impacted in this program. More details can be found in the site’s FAQs.

Secondly, the Biden Administration has mandated, effective January 15, that health insurance companies and group health plans reimburse members for the cost of at-home over-the-counter diagnostic COVID-19 tests authorized by the U.S. Food and Drug Administration (FDA). The public announcement has been widely misinterpreted as meaning that tests would be “free.”

The reality is more complicated. The details of the mandate provide two compliance options for carriers. The cost to members of at-home COVID-19 tests will depend on the compliance option that their carrier chooses to implement. Essentially:

  1. Carriers may provide an option of direct coverage of tests through both a pharmacy network and a direct-to-consumer shipping program. Tests ordered through direct coverage are a 100% covered benefit. The cost of tests purchased outside of this direct coverage option are to be reimbursed at a fixed dollar reimbursement per test.
  2. Carriers may choose to not provide a direct coverage option. Members can purchase tests from their vendor of choice. Members are to be reimbursed for the full cost of tests.

The number of tests covered is limited to no less than eight tests per 30-day period (or calendar month) per member.

The mandate does not apply to tests required for employment purposes. In the situation where an employer requires employees to submit COVID-19 test results as a condition of employment, the mandate does not require health plans to reimburse the cost of those tests.

As you can see, the result of the mandate is that at-home COVID-19 tests – with no out-of-pocket cost to the member – are indeed becoming more widely available. But it does not mean that all tests are provided with no copay nor does it mean that all purchases are a 100% covered benefit.

This article by law firm Morgan Lewis provides a good summary of the mandate.

Carriers are now implementing the new mandate. The challenges of implementation are well-summarized in this SHRM article. Journalists covering healthcare are also beginning to provide information to the public such as in this KQED article.

(These sources are provided for information purpose only. Health plan members should not make decisions based solely on what they read in the news.)

Currently, here are the best ways for individuals and families to obtain at-home COVID-19 tests:

  1. Tests may be ordered now from covidtest.gov. These are provided free of charge by the federal government.
  2. Individuals and families enrolled in group or individual health plans may have some or all of the costs of tests covered. Members should follow their carrier’s latest guidance on coverage of at-home COVID-19 tests. Contact us for assistance in helping your clients obtain this guidance.
  3. Individuals covered by an employer’s self-funded plan should contact their employer regarding the plan’s reimbursement obligations.

We will update you with more information as the carriers announce their implementations of the mandate.

Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.


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