Biden Administration, Health & Human Services
Department Announce Insurance Coverage for
COVID-19 Home Testing Kits at No Cost
All Fully Insured and Self-Funded Plans Will Be
Required to Cover At Home Tests Starting January 15
Insurance companies and group health plans will be required by the federal government to cover the cost of over-the-counter, at-home COVID-19 tests in most circumstances starting January 15th.
According to the Center for Medicaid and Medicare Services (CMS), the new coverage requirement means that consumers with private health coverage can go online or to a pharmacy or retail store, buy a test, and either get it paid for up front by their health plan, or get reimbursed for the cost by submitting a claim to their plan. This requirement ensures individuals do not need an order from their health care provider to access these tests for free.
Insurance companies and health plans are required to cover eight over-the-counter at-home tests per covered individual per month without any cost-sharing requirements such as deductibles, co-payments or coinsurance, prior authorization, or other medical management requirements so long as the at-home tests are purchased from an in-network provider. If the health plan has set up a network of preferred stores, pharmacies, or online retailers at which you can obtain a test with no out-of-pocket expense, you can still obtain tests from other retailers if you buy them outside of that network, however, the plan is only required to reimburse you up to $12 per individual test not to exceed the maximum allowed per month.
Plans are not required to provide coverage of testing (including an at-home over-the-counter COVID-19 test) that is for employment purposes. The Insurance Department will share any new information as it becomes available.
FAQs are available on the Center for Medicaid and Medicare Services (CMS) website, here.
Consumers can contact their health plan for more information on their plan and coverage or reimbursement for COVID-19 home test kits.
The State of Connecticut has COVID-19 information online at ct.gov/Coronavirus.
The Insurance Department’s Consumer Affairs Division is available to answer questions or assist consumer with a claim denial or resolving a complaint against their insurance carrier.
