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.
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.
For more information about Recuro’s capabilities, contact info@recurohealth.com