Large insurers are beginning to implement the Biden administration's new requirements to cover at-home COVID-19 tests, but some payers' policies are more consumer-friendly than others, according to a new analysis from the Kaiser Family Foundation.
While some insurers like UnitedHealth Group allow members to purchase rapid tests for free at in-network pharmacies or "preferred" retailers like Walmart, others including Cigna and Care First require members buy tests out-of-pocket and mail in claims for reimbursement.
KFF looked at the policies of 13 insurers that each covered more than 1 million people and found about half offer free direct coverage of at-home tests through pharmacies or retailers while the others require members file for reimbursement, either through a website or by mail.
Of the five insurers that don't currently offer direct coverage of tests, four require members to ask for reimbursement using a mail-in form: Blue Cross Blue Shield of Michigan, Blue Shield of California, Care First and Cigna.
Anthem doesn't have a direct coverage option but allows members to submit claims online. A spokesperson also said it has a limited number of at-home tests available for certain members to order online.
Kaiser Permanente plans to offer a direct coverage option but also allows for online reimbursement, according to the analysis. In a statement, the integrated provider and health plan said it is working "around the clock" to establish processes for member reimbursement.
"We are working to increase our supply and will soon make them available to our members through a number of outlets, including mail-order," a spokesperson said.
Blue Cross Blue Shield of Michigan said they are working on standing up a pharmacy network for members to have "easier access" to no-cost tests.
Blue Cross Blue Shield of North Carolina, Centene/Ambetter, Guidewell, Health Care Service Corporation, Humana and UnitedHealth Group all allow for direct coverage, either through in-network pharmacies or other retailers that they have partnered with. Some of those plans, including Blue Cross Blue Shield of North Carolina and Humana still require members seeking reimbursement for tests purchased out-of-network to mail claims.
Download Modern Healthcare’s app to stay informed when industry news breaks.
"That could be more complicated for consumers in some ways," said Lindsey Dawson, an associate director at KFF and co-author of the analysis.
"It's quite variable," Dawson said. "People are going to really have to understand what their own insurance company is doing and requiring and not look to what other people or their friends or their family might doing."
The Biden administration guidance issued last week requires commercial plans to reimburse policyholders for eight at-home COVID-19 tests per person per month. The policy took effect Jan. 15, sending some insurers scrambling to find tests or retail partners, said Ceci Connolly, president and CEO of Alliance of Community Health Plans, which represents small, not-for-profit payers. The administration first announced the requirement last month.
At-home tests are in high-demand and the effort has been complicated by the lack of tests available, she said, and ACHP insurers have struggled to find pharmacies or retailers to partner with.
"In the meantime, we worry people are going to get the impression there are eight tests with their name on them sitting at their local pharmacy," Connolly said.
Dirk McMahon, president and CEO of UnitedHealth Group, told shareholders on an earnings call Wednesday that the insurer partnered with Walmart and Rite Aid for consumers to get at-home tests for free within four-days of the mandate taking effect.
"We expect more partnerships in the days ahead," McMahon said. "As we look forward, we believe we have the right capacity in place to execute our business priorities and meeting our customers' expectations."
President Joe Biden has put a greater focus on rapid testing due to the omicron variant. The White House announced a separate effort this week to ship four free at-home COVID-19 tests per household per month to anyone who orders through covidtests.gov. More than 400 million N95 masks will also be free for people to pick up at pharmacies and other locations beginning next week.
