The administration of President Joe Biden announced today that it will require commercial health coverage providers to pay for at least eight home COVID-19 tests per person per month starting Jan. 15.
The rules apply both of health insurers and to self-insured employer health plans.
The administration wants to arrange for as many enrollees as possible to get home test kits at no out-of-pocket cost through in-network pharmacies and other locations.
When enrollees buy tests from other sources, insurers and plans will have to reimburse the enrollees for up to $12 per test.
Administration officials warned insurers and plans in December that a test kit coverage mandate was coming.
Government Plans
The federal government already requires Medicaid plan and Children's Health Insurance Plans to cover home COVID-19 tests.
The Centers for Medicare and Medicaid Services, the federal agency that regulates Medicare plans, says it lacks the authority to have the traditional Medicare program pay for home COVID-19 tests.
The original Medicare program will pay for one lab test performed without a physician order, without cost-sharing, per patient per year, and Medicare Advantage can set their own home COVID-19 test coverage rules, CMS says.
CMS did not talk about what Medicare supplement insurance providers are planning to do about coverage for home COVID-19 tests.
Why the Urgency?
The number of COVID-19 cases fell sharply in the summer, and public health program managers had hoped that vaccination programs and earlier social distancing efforts had gotten the pandemic under control.
But the COVID-19 delta variant caused a huge spike in hospitalizations and deaths in the fall, and especially among people ages 18 through 64 who had not been vaccinated.
Another, highly infectious variant, the omicron variant, began making headlines in late November. Officials had hoped omicron cases would be variant and have little effect on hospitalization rates or mortality rates, but, in late December, new hospitalization counts soared to record pandemic-period levels in much of the country. Officials now fear mortality rates will also spike, and they are looking for ways to get the omicron wave of cases under control.
"Testing is critically important to help reduce the spread of COVID-19, as well as to quickly diagnose COVID-19 so that it can be effectively treated," CMS Administrator Chiquita Brooks-LaSure said in comments about the new mandate. "Today's action further removes financial barriers and expands access to COVID-19 tests for millions of people."
What the Mandate Means for Insurers
The COVID-19 pandemic has led to a big increase in deaths in the United States and may have led to about $30 billion to $40 billion in extra death benefits payments so far.
If the new test coverage mandate holds down the number of deaths caused by COVID-19, and by pandemic-related health care system stress, it could reduce future life insurer spending on death benefits.
