Health plans required to cover in-home diagnostic tests

Health plans required to cover in-home diagnostic tests

2 min
January 20, 2022

For the Sentinel

MADISON – As of Jan. 15, all health plans are required to cover the cost of over the counter, at-home diagnostic COVID-19 tests for their members. This requirement applies to both private health insurance companiesand group health plans, like those provided by an employer.

Under these new guidelines, required by the Biden Administration, COVID-19 tests may either be free or reimbursed by the insurer.Health plans and insurance companies are incentivized to set up a network of pharmacies or retailers so their members can conveniently order or pick upthese tests that will be covered upfront.

“Access to testing is critical as Omicron continues to spread through our communities,” said Insurance Commissioner Nathan Houdek.“This new requirement will help stop the spread of COVID-19 by making it easierfor everyone to test themselves at home.”

If a health plan or private insurer establishes a network of pharmacies or retailers, then they are permitted to limit the reimbursement fortests purchased outside of that network to $12 per test.

If a health plan or insurance company does not set up anetwork to prevent upfront costs for their members, then they must reimbursethe full cost of the test, even if the test costs more than $12. Plans are required to cover eight individual tests per month for each person covered bythe plan.

Health plans and insurance companies are not required to cover nor reimburse the cost of testing that is not diagnostic in nature.

There are also testing options available for people who are uninsured. The state of Wisconsin has teamed up with Vault Medical Services to offer COVID-19 tests for everyone who lives in Wisconsin, with or without symptoms, at no cost. This new service allows people to collect their own saliva samples for testing in their home. For more information, visithttps://www.dhs.wisconsin.gov/covid-19/collection.htm.

This article was orginally reported by