Biden Administration Sets Home COVID-19 Test Coverage Rules
Private health insurers spent about $1.15 trillion on health care in 2020.
Private insurers cover more than 200 million U.S. residents.
If every privately insured U.S. resident bought eight $12 COVID-19 test kits out of network per month, the cost per person would be $96 per month. The cost for all privately insured people would be about $20 billion per month, or about 20% of what health insurers have been spending on health care claims per month.
But there are signs the cost of home COVID-19 tests could cost much less than $12 per kit. The Dutch version of Amazon, for example, sells packages of 25 home tests for only about $3 per kit, and the percentage of people who want to give themselves frequent home COVID-19 tests could be low.
If the average cost of a kit covered by insurers is $3, and only 10% of enrollees use their test kit benefits in a given month, average insurer spending on kit benefits could be less than $700 million per month.
Rule Delivery Mechanics
The administration described the rules through a press release and through a set of answers to frequently asked questions posted on the website of the Centers for Medicare and Medicaid Services, which regulates health insurers, and on the website of the Employee Benefits Security Administration, an arm of the U.S. Department of Labor, which regulates self-insured group health plans.
At press time, the agencies had not put a notice, draft regulation or other document related to the home test coverage mandate on the Federal Register website.
The versions of the test coverage mandate rules available at press time did not provide a mandate end date, or a discussion about the circumstances that would lead the government to end the mandate.
Insurer Reactions
Matt Eyles, the president of America’s Health Insurance Plans, an insurer trade group, said in comments about the Biden administration home test coverage rules announcement that AHIP members will work with the administration to implement the test benefits as quickly as possible, in ways the minimize consumer confusion and challenges.
“Every day, more Americans are being diagnosed with COVID-19,” Eyles said. “From the beginning, health insurance providers have taken decisive action to cover the costs of tests to diagnose and treat COVID-19 – and we continue to do so. We learned a great deal through that commitment and other key actions on COVID-19, and we recognize that the administration’s guidance takes steps to mitigate the real risks of price gouging, fraud, and abuse, which would limit access and reduce affordability for everyone.”
Eyles said the country must emphasize vaccination campaigns as well as testing to protect public health.
“We all know we cannot test our way out of this pandemic,” Eyles said. “COVID-19 vaccines are safe, effective, and free, and we encourage everyone to talk with their clinicians about vaccines and boosters.”
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Chiquita Brooks-LaSure (Photo: House Ways and Means Committee)
