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How will I be reimbursed for rapid COVID tests? And other FAQs

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Published: Jan. 12, 2022 at 10:57 AM CST
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(CBS News) - Consumers who are fortunate enough to get their hands on over-the-counter, rapid COVID-19 tests will soon be reimbursed by their insurers for the cost of such devices under new rules outlined by the White House this week.

The Biden administration on Monday said it will require private insurers to cover the cost of eight at-home tests per family member each month, in an effort to expand Americans’ access to rapid testing. While it is widely seen as a step in the right direction, critics of the plan argue that tests still remain hard to come by, and that they should either be sent directly to Americans or be free at the point of purchase, to ensure equitable access to rapid COVID-19 tests that have become an integral part of the country’s plan to contain the spread of the virus.

That said, the initiative encourages insurers to make tests available at no upfront cost to members by setting up networks of preferred retailers that insurance plans will later reimburse.

Read on for answers to frequently asked questions about the initiative.

Who is eligible? What if I’m not privately insured?

Under the plan, only Americans who are privately insured can seek reimbursement for rapid tests beginning Saturday, no prescription or prior authorization is needed, according to guidance released by the Health and Human Services Department Monday.

Americans who are uninsured, or who are covered by Medicare will not be able to seek reimbursement for over-the-counter tests they purchase. Instead, the White House said it will send 500 million at-home, rapid tests to Americans who order them through a forthcoming government website for free home delivery. The government will also provide 50 million free tests to community health centers and rural clinics for those Americans who are ineligible for reimbursement through the federal plan.

Are tests I already bought covered?

No. Consumers will not be retroactively reimbursed for tests they have already purchased. Insurers are only responsible for covering the cost of tests purchased on or after Saturday, January 15.

What kinds of tests are covered?

Every variety of over-the-counter COVID-19 test that is authorized for emergency use by the U.S. Food and Drug Administration is covered under the new initiative. Approved tests include Abbott’s BinaxNow at-home test, Quidel’s QuickVue antigen test and OraSure’s InteliSwab rapid test, among others.

Also on the list is Intrivo’s On/Go test, which recently earned a top ranking from an independent patient safety group that evaluated a handful of tests based on their ease of use.

ECRI, the independent nonprofit organization, gave the test a “very good” score from a usability perspective. The BinaxNow, QuickVue and InteliSwab tests were found to have “good” usability, ECRI reported.

At-home test kits could still be harder for laypeople to administer themselves, the nonprofit noted. “We had scientists and engineers who are trained to handle complex medical devices evaluate them,” ECRI president and CEO Marcus Schabacker told CBS MoneyWatch.

Where can I buy them?

Rapid at-home tests remain hard to find throughout the U.S. “This is due to the mismatch between supply and demand,” said Carri Chan, a testing expert and professor of operations at Columbia Business School. “Demand is through the roof right now; it is very challenging to find tests. When they are available, they get snapped up right away.”

Rapid tests are available in limited quantities online and in brick-and-mortar stores. Health company Ro, once known for catering to men’s health concerns like hair loss and erectile dysfunction, has On/Go tests in stock, and permits customers to purchase as many as 12 test kits per order. Each kit, which comes with two tests, costs $30.

Is there a limit to how many tests I can purchase?

Yes. The Biden administration requires insurers to cover the cost of up to eight tests per month, or almost two tests a week per individual.

Will I automatically be reimbursed the full amount?

It depends. Under the guidelines, the Biden administration encourages private insurers to make tests available to members for free at the point of purchase by creating networks of preferred retailers, including pharmacies. Insurers would then reimburse the retailer, rather than the consumer, for the cost of the test.

“The way the language is written, if an insurer sets up a preferred network of retailers, they can use that to provide direct coverage to the patient at the point of sale,” said Caitlin Donovan, a spokesperson for the National Patient Advocate Foundation. “They wouldn’t have to seek reimbursement, then. Essentially, the insurer would be reimbursing the seller of these tests.”

If a member purchases a test outside of a preferred network, insurers are only required to reimburse at a rate of $12 per test, according to the White House, leaving insured customers on the line for some of the cost of pricier test varieties.

If no preferred provider network exists, insurers must reimburse consumers the full cost they pay for the tests. In these cases, privately insured consumers will have to save their receipts and submit them to their insurance company to be reimbursed.

“If a provider doesn’t set up this network they have to reimburse for whatever purchase price is. That’s the incentive to get them to set up networks,” Donovan added.

The networks also absolve patients of having to navigate often complex reimbursement systems and procedures.

“The administration is encouraging insurers to make tests freely available to people without having to do the reimbursement legwork by creating networks so individuals can just go in and get tests,” said Lindsey Dawson, a testing expert at KFF.

“Roughly two tests a week per American is certainly more than the average person in the U.S. is doing right now. Whether it’s enough is something we’ll have to watch,” she added.

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