The Biden administration on Monday issued rules requiring private health insurers to cover the cost of at-home COVID-19 tests starting Jan. 15 amid pressure to make testing more available.
Under the policy, insurers will be required to cover the cost of eight at-home COVID-19 tests per person each month.
The broad outlines of the policy were first announced by President BidenJoe BidenDeputy AG: DOJ investigating fake Trump electors On The Money — Vaccine-or-test mandate for businesses nixed Warner tests positive for breakthrough COVID-19 case MORE in early December, but the new rules provide details — such as the number of tests that will be covered — for the first time.
The steps come as the Biden administration has faced intense pressure to do more to increase availability amid reports of long lines for PCR tests and pharmacies selling out of rapid at-home tests.
Experts criticized the announcement when Biden made it last month for relying on consumers to pay for the tests upfront at a pharmacy or other retailer and then get a reimbursement from their insurer after the fact, a cumbersome process that could discourage people from seeking tests.
The administration took some steps to try to address that issue in Monday’s rules by incentivizing insurers to cover the cost of tests upfront. If insurers establish a network of preferred pharmacies or retailers where they pay upfront for the tests, then they could cap their costs at $12 per test at pharmacies outside that network.
“The Biden Administration's testing guidance protects insurers against price gouging by unscrupulous retailers, but only if the insurance company provides a way for consumers to get at-home tests for free at pharmacies with no upfront payment,” tweeted Larry Levitt, a health policy expert at the Kaiser Family Foundation.
Despite the new rules, there is still the issue of whether at-home rapid tests will be in stock and on store shelves for people to buy in the first place given that finding the tests has often been difficult amid the omicron wave.
“The success of the Biden Administration's requirement that insurers pay for at-home COVID tests will depend, of course, on being able to snag those valuable tests to begin with,” Levitt added.
The rules also do not apply to people who get insurance through Medicare or who are uninsured.
Following pressure to do more to make tests free, the administration is also moving forward with plans to distribute 500 million free tests starting this month.
Experts have praised that move as a step but noted that far more than 500 million tests will be necessary given the U.S. population of about 330 million people.
“Under President Biden’s leadership, we are requiring insurers and group health plans to make tests free for millions of Americans,” said Health and Human Services Secretary Xavier BecerraXavier BecerraThe Hill's Morning Report - Biden to make voting rights play in Atlanta Democrats eager to fill power vacuum after Pelosi exit Overnight Health Care — Insurance will soon cover COVID-19 tests MORE. “This is all part of our overall strategy to ramp-up access to easy-to-use, at-home tests at no cost.”