Guidance has been issued regarding the requirements for group health plans and health insurance carriers to cover over-the-counter (OTC) COVID-19 diagnostic tests beginning January 15, 2022.
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.
Under guidance issued in June 2020, at-home COVID-19 tests had to be covered only if they were ordered by a health care provider who determined that the test was medically appropriate for the individual. At that time, the FDA had not yet authorized any at-home COVID-19 diagnostic tests. Since then, several types of OTC at-home tests have been approved.
As of January 15, 2022, the cost of these tests must be covered, even if they are obtained without the involvement of a health care provider.
Insurance companies and health plans are required to cover 8 OTC at-home tests per covered individual per 30-day period.
There is no limit on the number of tests, including at-home tests, that are covered if ordered or administered by a health care provider following an individualized clinical assessment, including for those who may need them due to underlying medical conditions.
Plans are not required to provide coverage of testing (including an at-home OTC COVID-19 test) that is required by an employer for employment purposes.