This week, the Biden administration announced a policy requiring health plans to cover the cost of over-the-counter COVID-19 tests. 

For people with private health insurance, which is about 45% of the U.S. population, those costs will be covered starting Saturday, January 15. 

Health care providers are required to cover costs for eight at-home COVID tests a month, for every member on a health plan. 

For example, a family of four could get 32 tests covered each month. 

What You Need To Know

  • Health care providers are required to cover the cost of eight at-home COVID tests a month, per member, starting Jan. 15 

  • A family of four, for example, can get 32 tests covered each month

  • You can get a test for no out-of-pocket cost at your plan’s “preferred” pharmacy. If your plan doesn’t list a “preferred” retailer, the provider is responsible for all claims, with no price limit. If you buy a test somewhere else, you can file a claim and get reimbursed up to $12 a test 
  • Providers without “preferred” retailers will be responsible for whatever claims a consumer submits, with no price limit.

The Department of Health and Human Services says it’s part of its plan to expand access to free testing, adding most people with private coverage can buy a test and have it either paid for upfront, or get reimbursed, depending on your plan. 

Health plans can list “preferred” pharmacies, where people can buy tests for no out-of-pocket charge. 

Providers without “preferred” retailers, will be responsible for whatever claims a consumer submits, with no price limit. 

If you buy a test somewhere else, you can file a claim and get reimbursed. 

At those out of network places, the insurance companies’ responsibility will be capped at $12. 

Consumers will be required to pay the difference. 

Nancy Moran works in the music industry, specializing in marketing and events, all of which are happening online, for now. 

When in-person events do return, at-home tests will likely play a big role. 

Moran says she’s only ever taken one at-home test. 

“I had to pay for the test kit out of my own pocket,” Moran said. 

The Biden administration has faced a lot of criticism over its handing of at-home tests, or the lack thereof. 

In many European countries, rapid tests have been much more accessible, not to mention free, for months already. 

While the general consensus is that this policy is good progress, there are some concerns. 

Health litigator Steve Lucke says at-home tests will only be reimbursed if they’re for diagnostic reasons, meaning if someone’s been exposed or is experiencing symptoms. 

The guidelines say the tests will not be reimbursable if you need to show proof of testing for things like return to work, travel, or to get into an entertainment venue. 

Lucke says the problem is, reason for testing is hard to prove. 

There’s nothing stopping anyone from saying they had an exposure, or have a sore throat — even if that’s not true.

The policy doesn’t require proof from buyers, nor does it allow health plans to ask for a reason for testing. 

“So it’s story of on the honor system at this point,” Lucke said. 

That’s on top of, perhaps, the two biggest concerns.

The first is the accuracy of these tests, which has been undercut in recent weeks by the omicron variant.

The second is retailers ability to keep their shelves stocked, which has proven to be a challenge at different points throughout the pandemic.