At-home COVID tests to be covered by insurance—but details still to come

WASHINGTON — State health officials on Thursday welcomed the Biden administration’s plan to require private health insurers to reimburse Americans for the cost of rapid, at-home COVID-19 tests—though the officials also raised questions about whether the process will be burdensome.

Making those tests more accessible will allow Americans to get results quickly and in the privacy of their own homes. That change may encourage more people to swab their nose when they first notice potential symptoms, experts from the Association of State and Territorial Health Officials told reporters.

“In this next phase of the pandemic, rapid access to rapid testing will be key,” said Dr. Nirav Shah, director of Maine’s Centers for Disease Control and Prevention, adding that it can help to combat potential surges and to pinpoint infections quickly so antiviral treatments can be used. 

But several challenges could limit the impact of the cost reduction.

That includes lingering problems with sufficient supplies, uncertainty about the details of the reimbursement process, and questions about any potential effect on the data that’s reaching state and local health departments about infections in their communities.

Official guidance in January

Under the proposal that President Joe Biden announced Thursday, three federal departments — Health and Human Services, Labor and the Treasury — will issue official guidance by Jan. 15 that will detail what exactly private insurers must cover when it comes to rapid COVID-19 tests.

Those insurers already are required to pay for the PCR tests that must be sent to a laboratory for processing and take longer for results.

The upcoming change requiring insurance coverage of rapid, at-home tests, won’t be retroactive. That means Americans who have been shelling out roughly $25 for a package containing two of the popular Abbott BinaxNOW rapid tests can’t submit receipts for tests they’ve already purchased. 

Other details of that requirement were unclear Thursday, including if there will be any limitations on the number of at-home tests that must be covered.

While the Biden administration has sought to reduce supply bottlenecks in producing those tests, Shah said some states are still having difficulty acquiring large volumes of the Abbott at-home tests. 

That brand, which has been found to be highly accurate, has been relied on heavily even as more options have come on the market. Part of that demand comes from familiarity: Those administering tests in large settings have become familiar with their use.

What if you test positive?

Another challenge with increasing the use of at-home tests will be ensuring that individuals know what to do if they test positive. 

Michael Fraser, ASTHO’s chief executive officer, said state health officials have been discussing whether those at-home tests should include an insert to help explain who to call and other next steps, so that contact tracing can occur.

“There is some concern that with the increase in at-home testing, getting those results reported to state health departments might be difficult, because the result doesn’t automatically go to public health authorities,” Fraser said.

However, there won’t be many results to get to state and local health officials if Americans with private insurance balk at fronting the money for tests while they await reimbursement.

Shah said a more accessible model would be to have individuals show their insurance card at a pharmacy as they would when getting a flu shot or picking up a prescription, rather than being charged at the register.

Having to pay for the tests, then wait for repayment, “introduces an access challenge for a lot of folks,” he said.

The Biden administration also plans to boost the number of free at-home tests distributed at community health centers and rural clinics, though those are intended to aid those who are not covered by private insurance.