President Joe Biden’s announcement this week that private insurers will have to cover at-home COVID tests was welcome news for many — but several major health insurers say they are still working out the details of how tests will be covered, with the deadline to implement the plan only days away.
At-home tests for COVID-19 can provide a convenient alternative to waiting on a testing line in the cold. But testing frequently before going to work or school — at a typical cost of around $24 for a two-pack — can add up.
Starting January 15th, every individual with private insurance will be entitled to eight free at-home COVID tests a month, Biden announced Monday. That means a family of four will be entitled to 32 tests — worth roughly $384 retail. But how that coverage will work — and how easy it will be to take advantage of the home testing benefit — will depend on a person's health plan.
“The administration did not standardize how this process is going to work, either in terms of how you get reimbursed or a timeline for when plans have to send you the reimbursement payment,” said Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University's McCourt School of Public Policy. “So a lot of it is going to vary plan to plan, and really just depend on the type of insurance you have.”
In some cases, people will have to pay for their tests up front and then seek to get reimbursed by their health plan, which could involve some legwork. “People should definitely hang on to those receipts,” said Corlette.
But Biden is pushing health insurers to partner with pharmacies so that members can bring their tests to the counter, show their insurance card and take them home without having to pay anything up-front. This would work similar to picking up a prescription.
The catch is that plans could require members to go to a preferred, or in-network, pharmacy. If a member buys the test from an out-of-network pharmacy or retailer, they can still reach out to their insurance provider to get reimbursed up to $12 per individual test, according to Biden’s mandate.
Since not all pharmacies are regularly stocked with tests, this approach could pose a challenge. Sam Ackerberg, a Bed Stuy resident, said he and his partner try to test frequently for COVID-19 because his partner is exposed to a lot of people through his job at JFK airport. But Ackerberg said it’s been a while since he’s been able to find home-testing kits at his local Walgreens.
“I am very happy that I can have my health insurance either reimburse it or cover the tests, if I’m able to find them,” said Ackerberg, who is an attorney. “But I don't know if we have the supply.”
Others have raised concerns about whether the home-testing test companies that currently have FDA authorization for their products are producing enough tests to support Biden’s plan. The president is also seeking to make 500 million home test kits available for free for all Americans to order online via a government website that will be set up later this month — though it’s unclear how many each household will be able to receive.
Meanwhile, Biden’s insurance mandate does not apply to those on public insurance. New Yorkers covered by Medicaid are able to access up to eight free tests a month (one two-pack per week) for free — but only if they’re ordered by a Medicaid-covered health care provider, similar to getting a prescription. People with private insurance won’t have to deal with that hurdle under Biden’s plan.
Nearly half of New York City residents are insured through Medicaid, a public plan for people with low incomes, and those New Yorkers are likely the ones who would benefit the most from having home testing costs waived.
Traditional Medicare also does not cover at-home tests, although individual Medicare Advantage plans may opt to do so.
On Tuesday, WNYC/Gothamist contacted EmblemHealth, Empire BlueCross BlueShield, United Healthcare, Healthfirst, and Aetna — all insurers providing coverage in the New York City area. None were able to provide details on how they would cover at-home tests, despite the mandate taking effect in just a few days. Biden initially announced the plan — albeit with fewer details — early last month.
EmblemHealth said it is “actively reviewing both federal and state coverage regulations for testing, with plans to update our members by Jan. 15’s implementation so that they understand their coverage.”