Does my health plan have to cover the cost of at-home COVID-19 tests?

Post enrollment issues | Individual Health Insurance Employer-Sponsored Coverage

Yes, with some limitations. Guidance issued by the federal government in January 2022 established that insurers and group health plans are required to cover the full cost of eight at-home tests per enrollee per month. So, for instance, a family of four can receive up to 32 free tests for the household per month. Note that the test coverage requirement only applies to COVID-19 tests that can be completed entirely at-home by the enrollee – not tests in which an enrollee collects a sample that is then sent to a lab or provider for processing.

If you have purchased at-home COVID-19 tests this year, you can submit a claim to your insurer for reimbursement. Insurers must fully reimburse the cost of authorized at-home tests regardless of whether the test was deemed medically necessary by a provider. For more information on how to submit a claim for reimbursement, contact your insurer.

This coverage requirement extends through the end of the COVID-19 public health emergency (PHE). Based on determinations from the United States Department of Health and Human Services, the PHE is still in effect.

(CMS, FAQs about Affordable Care Act Implementation, Part 51, January 10, 2022).

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