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Starting January 15th, Insurance Companies Must Cover the Cost of At-Home Testing

Newly released guidance from the Departments of Labor and Treasury will significantly expand the scope of required coverage of at-home COVID testing without participant cost-sharing and without a physician order. Starting, Jan. 15, insurance companies must cover the cost of at-home testing, meaning most consumers with private health coverage can buy a test and either get the cost covered upfront or get reimbursed later by submitting a claim to their plan.

This is important news for current and prospective Recuro Health clients since we offer at-home COVID-19 tests as well as support for employers that must comply with OSHA testing requirements. Our structured solution provides a safe, convenient and confidential at-home and worksite lab testing experience. Insurer-covered testing is expected to dramatically reduce costs for many Americans and make COVID-19 tests more accessible to enable at-home testing and monitoring.

Details of Coverage Guidance

The new guidance beginning Jan. 15 affirms that the limit of eight tests is per beneficiary. The limit is only for the tests that a provider does not order — so a consumer with a provider order is eligible for additional tests without cost-sharing. When plans and insurers make tests available for upfront coverage through preferred pharmacies or retailers, they are still required to reimburse tests purchased by consumers outside of that network, at a rate of up to $12 per individual test (or the cost of the test, if less than $12).

The guidance also creates a safe harbor for plans that move forward with a so-called “direct coverage” process. For purposes of this safe harbor, direct coverage of over-the-counter (OTC) COVID-19 tests means that a participant, beneficiary, or enrollee is not required to seek reimbursement post-purchase; instead, the plan or issuer must make the systems and technology changes necessary to process the plan’s or issuer’s payment to the preferred pharmacy or retailer directly with no upfront out-of-pocket expenditure by the participant, beneficiary, or enrollee.

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