***Note: According to the Colorado Department of Health Care Policy & Financing, Health First Colorado (Colorado’s Medicaid program) is not able to reimburse members’ tests they may have purchased on their own. This web page features information for members that includes pharmacy locations and a number of FAQs.
(NEXSTAR) – When omicron started to take off in the U.S., the White House announced it would do more to help people access at-home COVID-19 tests. Starting Saturday, the biggest part of the plan so far takes effect.
Private health insurers are now required to cover eight home tests per month for each of their members.
Depending on when and where you purchase the at-home tests, which typically retail for about $25 for a kit containing two tests, you may be able to get it covered by insurance on the spot, says the Centers for Medicare and Medicaid Services.
But many people, especially in the program’s initial stages, will need to pay for the tests out of pocket and then file for reimbursement from their health insurance.
If you do pay out of pocket, you’ll want to keep your receipt as proof of purchase. You’ll need to file a claim for reimbursement with your health insurance company, not the federal government. (Call the number on your insurance card or check the company’s website for more information.)
Insurers are only required to cover kits purchased after Saturday, Jan. 15, so you might not have any luck filing a claim for tests you’ve bought in the past.
How much money you can be reimbursed for depends on if your insurer has set up a “network of preferred stores, pharmacies, and online retailers at which you can obtain a test with no out-of-pocket expense,” explains CMS.
If your insurance company has set up a way for your to get a test without paying upfront, then you will get up to $12 per test. If your insurer has not set up its own network or way for you to get the test through them, then they’ll owe you the full cost of the test kit, even if it’s more than $12.
“For example, if an individual buys a two-pack for $34, and the plan or insurer has not set up a system to cover costs upfront, then the plan or insurer would have to reimburse the $34 instead of $24,” says CMS.
You won’t need to meet any sort of deductible first in order to qualify.
Each insured individual qualifies for eight tests per month. That means a married couple would be covered for 16 tests per month and a family of four would get 32.
Some people may be granted an exception to the eight-test limit by their doctor if more regular testing is needed for an underlying medical condition, for example.
The trouble, for the time being, will be finding these at-home tests in stores. Many pharmacies and online retailers are still sold out or in short supply.
All of the above requirements only apply to people covered under private health insurance. People covered by Medicare, an estimated 18% of the American population, won’t be able to get the cost of at-home test kits reimbursed by their insurance plan.
However, people covered by Medicaid and Children’s Health Insurance Program (CHIP) will be eligible for reimbursement, and they should check with their state program for specifics.
The government plans to distribute 1 billion at-home rapid tests, as well as N95 face masks, directly to Americans. Anyone, regardless of health insurance status, will be eligible. Americans will also soon be able to sign up to get a test mailed to them.
On Friday, the White House announced the federal website where Americans can request free COVID-19 tests will begin accepting orders on Wednesday, Jan. 19. Supplies will be limited to just four free tests per home.
The Associated Press contributed to this report.