Insurance Companies Are Now Required to Cover Up to 8 At-Home COVID Tests a Month—Here's How to Take Advantage

One thing experts don't want you to do is stockpile the tests.

COVID-19 testing is an important way to prevent virus transmission. And thankfully, there are at-home COVID tests that make the process easy—no searching for a testing appointment at local pharmacies or waiting in a long line at a pop-up testing site. However, those at-home tests can be expensive, so it's not always realistic to keep them on hand or test whenever you need to. But now, thanks to a new policy enacted by the Biden-Harris Administration, cost no longer has to stand in the way of at-home testing for Americans with private health coverage.

Earlier this week, the administration announced that, starting January 15, insurance companies and group health plans will be required to cover the cost of over-the-counter, at-home COVID-19 diagnostic tests that have been authorized, cleared, or approved by the US Food and Drug Administration (FDA). The policy also outlines exactly how many tests will be covered: up to eight at-home tests per covered individual per month. That means that if all four members of a family share the same health insurance plan, the household can get up to 32 at-home COVID tests covered by their health plan per month.

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The move is part of the continued effort to expand Americans' access to free testing and slow the spread of COVID-19. Without cost as a barrier, more people can access tests and, hopefully, prevent spreading the virus to others. But experts say just because tests will be available to you for free doesn't mean you should stockpile them—and it will still be important to follow the Centers for Disease Control and Prevention (CDC) guidelines for when to self-test.

Here's what you need to know about the new requirement and how it should impact the amount of at-home COVID-19 tests you buy and use.

What does this new policy mean for Americans?

The new coverage requirement means that if you have private health insurance coverage or are covered by a group health plan, you can buy a COVID test online or at a store and get it paid for by your health insurance company/group health plan either up front or by submitting a reimbursement claim (in which case you'd pay up front and get a check from your insurance for the cost later), according to the US Department of Health and Human Services (HHS) press release. If your health plan doesn't provide direct coverage at the point-of-purchase and you need to submit a claim for what you paid out-of-pocket, then make sure to keep your receipt. Either way, there will be no cost-sharing requirements, such as deductibles, co-payments, coinsurance, or prior authorizations, for you to worry about.

To encourage insurers and plans to pay for tests at the point-of-purchase—and to avoid Americans having to pay out-of-pocket and submit reimbursement claims—the Biden-Harris Administration is giving insurers and group health plans the option to set up a network of preferred providers. If your insurer or plan does this and you buy a test from one of the preferred providers, your test will be covered in full, typically at the point-of-purchase. If your insurer or plan sets up a network of preferred providers and you get a test from a retailer outside of that network, that's fine, but you will be reimbursed only up to $12 for each test after submitting a claim. The HHS recommends that you check with your insurer or plan to find out if it will be setting up such a network and exactly how it will cover over-the-counter tests.

Regardless of whether your insurance company or group health plan sets up a network of preferred providers, it will have to cover the over-the-counter tests even if you don't have a health care provider's order or an individualized clinical assessment before purchasing the test. Just make sure that the test you buy is on the list of FDA-authorized tests, as that is one of the requirements for coverage.

Again, the Biden administration's latest mandate requires that insurance companies cover eight tests per policy member per month. But the HHS makes this clear in its press release: "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."

Tests currently available over-the-counter at drug stores and online are generally antigen tests. They detect the SARS-CoV-2 antigen, the antigen of the virus that causes COVID-19 and the presence of which implies current COVID infection. While antigen tests might be less sensitive and less reliable for people without symptoms compared to PCR tests, which detect the actual genetic material of the virus, they are still highly accurate. The at-home tests give results faster than PCR tests, and you can self-administer them, so they're convenient if you need results sooner or simply can't get an appointment for a PCR test.

The new policy could also encourage more people to test for COVID-19 who may not otherwise do so due to cost. After all, some insurance policies require members to dish out money out-of-pocket for PCR testing, Sten Vermund, MD, PhD, an infectious disease epidemiologist and pediatrician at Yale School of Public Health, tells Health. Giving people the free access to at-home tests, he says, could discourage unnecessary spread of the virus.

Of course, the new requirement only affects those with private health coverage. What about everyone else? The HHS provides information on how Americans who aren't insured can still access free COVID testing through community-based testing. And the Centers for Medicare & Medicaid Services lists upcoming programs that will provide at-home tests for the uninsured, as well. As for state Medicaid and the Children's Health Insurance Program, the HHS points out that those programs are already required to cover FDA-authorized at-home COVID-19 tests without cost-sharing. Finally, the new requirement does not include Medicare, which only covers COVID-19 diagnostic tests when they are performed by a laboratory and when the test is ordered by a physician, non-physician practitioner, pharmacist, or other authorized health care professional, per the HHS.

Should you buy as many tests as possible?

Theoretically, if you have private health coverage, you could go to the store and buy eight tests for every covered individual on your policy starting Saturday—but experts caution against stockpiling tests just because they're free and available. Instead, keep a few on hand and re-stock your supply after you use them. "To have one or two rapid tests in your home is convenient, but to stockpile them would be limiting access to people who might need them more acutely and could lead to a test shortage," Dr. Vermund says.

Another reason not to buy every test on the shelf: COVID-19 tests don't have an endless shelf life (you can usually find the use-by date on the packaging). "The expiration date is usually many moons from when you buy it, but if you stockpile you might end up throwing them away or using them when they aren't valid," says Dr. Vermund.

When should you take an at-home COVID-19 test?

Now that over-the-counter tests are available at no cost to the privately insured, you may be wondering if you should test more frequently. The CDC currently recommends taking a COVID-19 test in a few scenarios: if you have symptoms, if you have a known or suspected exposure to COVID-19, and for self-screening purposes before traveling (or as required by schools, workplaces, and health care providers).

Those guidelines still apply for at-home testing, Joel V. Chua, MD, chief of surgical infectious disease service at University of Maryland Medical Center and assistant professor at the University of Maryland School of Medicine Institute of Human Virology, tells Health.

As a rule, Dr. Chua says it's a good idea to keep one or two tests at home and to test as soon as you can if you develop COVID-19 symptoms like:

  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea

It's also appropriate to self-administer a rapid test if you recently had close contact with someone who was diagnosed with COVID-19. Dr. Chua usually tells people to delay testing until five days after exposure if they're not symptomatic or to test as soon as symptoms develop. If the test is negative, follow the test instructions and try again in a few days. (At-home rapid tests usually come in two-packs for this reason.)

Another time you may want to use an at-home test is to self-screen before potentially exposing a high-risk individual. If you're going to see your elderly grandparents or a friend with a medical condition that makes them high risk for severe illness with COVID-19, you can use your test to make sure you're not unknowingly asymptomatic beforehand.

Both Dr. Vermund and Dr. Chua agree that while occasional screening may be necessary, there's no need to routinely test without symptoms or a known exposure. The one exception, Dr. Vermund says, is if you're considered high risk for catching COVID-19—for example, if you live in a college dorm or play on a sports team, you might be required to test every week. Workplaces sometimes require routine testing, too. "For the rest of us, if we take reasonable precautions, it simply isn't practical to be testing 330 million Americans in a routine fashion," Dr. Vermund says.

If you test positive on a rapid test, Dr. Chua says you can assume you're infected and follow CDC guidelines for isolating. Again, antigen tests are generally less sensitive than the PCR tests, so even if you're infected, you could get a negative result if you test at the wrong time (which is why he recommends testing again later after an exposure). But antigen tests authorized by the FDA should be close to 100% specific—which means a positive is usually a positive. If you want to be extra sure about a result, you can also get a PCR test.

No matter when or how you test for COVID-19, it's important to continue other precautions: Get vaccinated, get boosted when you're eligible, and continue taking precautions like masking in groups (and, if possible, upgrading your mask). "We have many tools in our battle against coronavirus, and all of them put together are pretty powerful," says Dr. Vermund.

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