Private insurers will have to cover 100% of the cost of at-home coronavirus tests, President Joe Biden announced Thursday in laying out a plan to combat COVID-19 during the winter months.
“The bottom line, this winter, you’ll be able to test for free, in the comfort of your home and have some piece of mind,” Biden said.
Many of the details of that requirement must be worked out through the rule-making process.
While experts have encouraged the administration to expand testing, the administration is taking a different approach from some other nations that essentially distribute free tests to anyone who wants them.
Biden’s strategy – which also includes tighter travel rules, efforts to get more Americans vaccinated and boosted, and more – comes as a new variant is quickly spreading around the globe. Even before the omicron variant emerged, Biden had planned to roll out additional steps in advance of winter, when people stay inside more and are gathering and traveling for the holidays.
Experts say the details of the Biden administration’s new testing rule will be critically important.
“Anything that removes the financial barriers to accessing testing is great,” said Jennifer Nuzzo, an epidemiologist and senior scholar at the Johns Hopkins Center for Health Security. “How much of an impact that will have will depend on the details.”
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Here’s what we know now about how it will work and whether it will be effective:
Q. What tests are already covered by insurance?
While insurers have been required to reimburse the cost of COVID-19 tests administered at testing sites and medical offices, there’s been no requirements to pay for home tests consumers can buy without a prescription at retail stores or online. Consumers largely have paid for these tests that can cost $25 or more – a price tag that makes routine testing unaffordable for many Americans.
Q. When will this start?
The administration expects the new rule to be issued mid-January. The rule insurers must follow will fill in the details about when reimbursements will start and under what conditions, such as whether someone must first have symptoms.
“What will have the most impact is if the cost of all tests are covered, regardless of symptoms or reason for testing,” Nuzzo said. “We’re at the stage of the pandemic where we’ve got vaccines, we’re trying to get back to normal and the way that we do that is by using tests to check people’s status, so they can safely return to work.”
Q. How will people get reimbursed?
People will have to file a claim with their insurance company for the over-the-counter tests, White House press secretary Jen Psaki said Thursday.
Q. Why isn’t the government subsidizing the price of tests, as some other countries have done?
Psaki said the administration’s medical team looked at a range of options.
“This is a step that our team agreed was implementable and possible to do now,” she said, “and we will continue to build on it.”
Free tests are readily available in pharmacies in England.
In Germany, residents had been able to get at least one free antigen test per week. That was ended in October as a way to encourage more people to get vaccinated, but reinstated in November as infections spiked.
On Thursday, German Chancellor Angela Merkel announced that people who aren’t vaccinated will be excluded from nonessential stores, cultural and recreational venues. ,
Q. What do experts think?
Insurance reimbursement for at-home tests is “hardly the most efficient way to give people better access to affordable testing,” according to Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation.
“But, it is something the Biden Administration can do quickly with existing authority,” Levitt tweeted, “and quick action is important right now.”
Q. Are the insurance companies on board?
America’s Health Insurance Plans, the trade association for private insurers, did not specifically say whether the group supports or opposes Biden’s requirement in a statement Thursday.
Spokeswoman Kristine Grow said AHIP “will make sure that the full impact of these actions on patients, consumers, and hardworking families is understood.” Grow said those impacts include ensuring access to affordable testing while protecting against price gouging on tests and higher insurance premiums.
“The most effective way to protect yourself, your family, and your community from COVID-19 is to get vaccinated, including boosters,” Grow said in the statement.
Q. How many people could be helped by the requirement?
About 56% of Americans have a private insurance plan, according to the Kaiser Family Foundation. The other 36% who have insurance are covered through a government plan like Medicare or Medicaid.
Q. Will people on government plans get reimbursed for at-home tests?
No. But the administration is increasing the number of free tests available at health centers, rural clinics and other community sites. Officials also emphasized that there are 20,000 locations where people can get free COVID tests today.
Q. Why is the federal government able to require insurers pay for the tests?
Previous legislation passed by Congress to address the pandemic required insurers to cover testing. The administration said it has determined that should apply to at-home tests, as well as to those conducted at a health center.