According to the new White House coronavirus testing program, health insurance companies are now required to cover the cost of eight home COVID-19 tests per month for their members. But the program leaves the exact reimbursement and coverage processes up to insurance companies – and perhaps unsurprisingly, so far the systems for covering test costs are sometimes difficult and often confusing.
The White House issued a mandate that insurance companies would begin covering the costs of the tests from January 15. Insurers are required to reimburse members for FDA-cleared tests purchased on or after that date, up to $12 per test. Companies can also choose to set up partnerships with retailers and pharmacies to make the tests available free of charge at checkout, and without the need for reimbursement.
If the insurer doesn’t have a partnership program where you can get initial coverage at certain retailers, they must reimburse the full price, even if it exceeds $12 per test.
This week, several of the nation’s largest health insurance companies — including Aetna, Cigna, Humana, UnitedHealthcare and others — began posting details on exactly how you can get reimbursed for your home tests and / or where to buy the tests if you want covered from the start, at the point of sale.
Many insurers have yet to release details of their coverage plans. Of those that have, Money has found that the process is often vague and may require physically sending (or faxing!) reimbursement forms and COVID-19 test receipts. In some cases, even the barcodes on the test kit packaging may need to be included.
The basic requirement for insurers is that they are not allowed “to design their reimbursement process in a way that unduly delays your reimbursement,” according to the Centers for Medicare and Medicaid Services (CMS). But that doesn’t necessarily mean the process is easy.
This program is for privately insured Americans only and is separate from the home delivery program via COVIDtests.gov – which provides a one-time shipment of four free home COVID-19 tests to everyone, regardless of health insurance status.
How to get insurance to cover the costs of the COVID-19 test
Here’s a look at what some of the nation’s largest insurers require.
Details of Aetna’s COVID-19 home testing coverage were released this week. The company released a FAQs on the program, which he updated frequently.
“In most cases, OTC [over-the-counter] testing will be covered by your drug benefits,” its website says. “Just check your benefits card to find your prescription benefits manager.”
You can find a list of nearby Aetna partner pharmacies using this pharmacy search tool. Tests purchased from partner pharmacies should be free at checkout (assuming you can find them available). Tests you purchase outside of these partners are eligible for reimbursement. In those cases, Aetna says you’ll need to submit a refund request but didn’t provide details beyond that.
Anthem recently updated its website with new information about the at-home testing program, but coverage details are still scarce.
“You may have to pay out of pocket at the time of purchase, but save your receipt to submit a claim online,” its website says.
Anthem has not publicly released a list of partner pharmacies or retailers that offer initial coverage, and the company did not respond to Money’s request for comment.
If you have health coverage through Cigna, you will need to print and complete this home COVID-19 test reimbursement form.
At this time, the only submission instructions are to fax the completed form to 859-410-2422 or physically mail it – along with receipts – to the address on the back of your Medicare card.
Cigna did not release a list of partner pharmacies or retailers for initial coverage and did not respond to Money’s request for comment.
To receive a refund with Humana, the company requires you to print and complete a refund form, keep your receipts and UPC numbers (or barcodes) for testing and mail them all to the address on the back of your insurance card. If you live in Puerto Rico, you must use a separate reimbursement form (which is in English and Spanish).
To avoid this reimbursement process, you can benefit from initial coverage at certain partner pharmacies. Humana has a pharmacy search tool on its website which you can use to find in-network pharmacies nearby.
The company did not respond to Money’s request for more information about its partner pharmacies and retailers.
UnitedHealthcare released detailed information about the new federal program and how it will cover COVID-19 home testing for you.
The company is partnering with Walmart Pharmacies, Sam’s Club, Rite Aid and Bartell Drugs to provide free at-home COVID-19 testing to members. You can go to these locations and receive tests at no cost as long as you show them your UnitedHealthcare card with an OptumRx logo on it.
If you buy home tests outside of these four pharmacy retailers, you can get reimbursed by submitting a claim online at monuhc.com or by filling this reimbursement form and mail it to the address on the back of your insurance card.
Did you struggle to get your health insurance fund to pay for your home COVID-19 tests? We want to hear about it. Send an email to [email protected] about your experience.
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