Plan Coverage of COVID-19 Testing in 2022

President Biden recently announced that health plans will be required to pay for at-home tests to detect COVID-19.  What does this announcement mean for your health plan?

Currently, we have no guidance that spells out the requirements for health plans, not even an effective date other than “January.”  Under existing guidance, COVID-19 tests must be covered without participant cost-sharing, but only when ordered by an attending health care provider who has determined the test is medically appropriate based on current accepted standards of medical practice.  If the test is for employment purposes, such as under a vaccination-or-test mandate, the plan is not required to pay for the test.

ASR-administered medical plans cover – without cost sharing – medically necessary COVID-19 tests that are FDA-approved or authorized for emergency use by the FDA.  Non-medically necessary tests would not be covered, such as for conditions of employment or public monitoring.

Note that at-home tests for COVID-19 are eligible for reimbursement under a medical FSA and an HSA, but are not necessarily covered under a medical plan at present.  The government clarified that the testing coverage requirement does include at-home COVID-19 testing, but only if the at-home COVID test “is ordered by an attending health-care provider who has determined that the test is medically appropriate for the individual.”  Additional guidance on medical plan responsibility to pay for at-home testing is expected to be issued on 15 January.  Until then, claims may be denied or suspended for more information, specifically for substantiation of a physician’s order of medical necessity.

Check the Announcements section of the ASR Health Benefits Website for up-to-date information on coverage for COVID-19 testing.