How well are insurers doing on implementation of COVID home-test reimbursement?
Maor insurers are taking different approaches to implementing payment procedures and communicating them to customers.
The Biden administration hopes that requiring private insurers to cover the cost of up to eight at-home rapid COVID-19 tests each month will help slow the spread of the virus and improve outcomes. Now the focus shifts to carriers as they implement payment procedures and communicate them to customers.
KFF reviewed coverage and reimbursement policies for the 13 private insurers with at least one million fully insured members across their U.S. subsidiaries. About half are implementing their testing coverage policy using only reimbursement.
- Seven insurers (Anthem, Blue Cross Blue Shield of Michigan, Blue Shield of California, Care First, Cigna, CVS Group/Aetna and Kaiser Permanente) are relying only on reimbursement practices.
- Four (Blue Cross Blue Shield of Michigan, Blue Shield of California, Care First and Cigna) require that receipts and a form be mailed in.
- Three insurers also require UPC or product barcode information to be mailed with the receipt.
The other half had a direct coverage option set up at the time of review.
- Blue Cross Blue Shield of North Carolina, Centene/Ambetter, Health Care Service Corporation, Guidewell (Florida Blue), Humana and United Health Group commercial plan enrollees can purchase rapid tests at an in-network or preferred pharmacy and will not have to pay anything upfront.
- Five of the six insurers with a direct coverage option (Blue Cross Blue Shield of North Carolina, Centene/Ambetter, Guidewell, Humana and United Health Group) also lay out how enrollees can seek reimbursement for costs they have fronted with retailers outside the preferred network, typically by mail and one also providing an online option.
Enrollees in plans with a direct coverage option may limit reimbursement to $12 per test if a test is purchased outside of this option.
- Of the six insurers with the direct coverage option, five specify that claims outside the preferred network are subject to a maximum reimbursement of $12 per test. These insurers include Blue Cross Blue Shield of North Carolina, Centene/Ambetter, Guidewell, Health Care Service Corporation and United Health Group
One insurer (Humana) with direct coverage did not list a maximum reimbursement amount.
“People who find rapid tests may also have difficulty navigating the reimbursement or direct coverage process,” KFF researchers concluded. “Still, this new policy is a step toward improving COVID-19 test accessibility and affordability in the United States.” ###