Coverage of OTC COVID-19 Tests
As of January 15, 2022, insurance plans need to cover the cost of over-the-counter (OTC) at-home COVID-19 Tests. For most individuals with health insurance the cost of these tests must be covered, even if they are obtained without the involvement of a health care provider.
Health plans and issuers must cover the costs of COVID-19 tests during the COVID-19 public health emergency without imposing any cost-sharing requirements, prior authorization, or other medical management requirements.
Tests are covered up to a maximum of $12 per test, with a limit of eight (8) tests per month or 30- day period. However, plans are only required to cover tests intended for diagnosis or treatment. Coverage of routine screenings for employment, school, or recreational purposes will continue to be excluded.
On January 10, 2022, the Department of Labor, Health and Human Services (HHS), and the Treasury issued FAQ guidance regarding the requirements for group health plans and health insurance issuers to cover over-the-counter (OTC) COVID-19 diagnostic tests.
Several types of OTC at-home tests have been approved by the FDA, and may be available through your health care provider, local pharmacies or online retailers. Each medical provider may have their own requirements for seeking reimbursement for tests purchased online or at local pharmacies such as CVS, Rite-Aid, etc. Check with your health care insurance provider for more information.