Jan. 17 — WASHINGTON — If you thought the very notion of getting a Covid-19 test was just too confusing, be forewarned: the range of testing options is expanding yet again.But that is actually good news. Thanks to dual actions by the Biden administration, soon you probably won't have to pay anything for at-home tests.
Starting last Saturday — Jan. 15 — private insurers have to start covering the cost of over-the-counter at-home tests. And four days later, on Wednesday, the federal government will unveil a website where Americans can order free tests to be mailed to their homes.
Hence the additional confusion. Even with those new testing options, people will still be able to go to local pharmacies, health clinics and private labs for Covid-19 tests of one kind or another, which are free if ordered by a physician, but which can cost upwards of $150 if they are not.
So, what is a person with a cough or the sniffles to do? It's confounding, said Rep. Brian Higgins, a Buffalo Democrat.
"You've got a mix of free tests," Higgins said. "We've got some people that are still paying. I mean, what is going on here?"
Here's an attempt to answer that question, and others you might have, about the recent testing changes taking place as metro Buffalo and the nation confront the Covid-19 wave brought on by the Omicron variant:
What is going on here?
What's going on is that the Biden administration is trying to ramp up Covid-19 testing in more ways than one by adding to — and not replacing — the elaborate network of testing sites that began to evolve at the start of the pandemic 22 months ago.
"We're seeing real improvement in testing," Biden said last week. "When I got here, we were doing fewer than 2 million tests a day. Now, it's changed. ... This month, it's estimated that we will hit approximately 15 million tests a day and we'll have over 375 million at-home rapid tests in January alone. That's a huge leap."
The administration sees testing as key to understanding the pandemic, as well as treating those suffering from Covid-19. And that's why it launched a two-track effort to increase distribution of at-home tests that can determine whether people have Covid-19 in as little as 15 minutes.
It's important to remember both of those tracks, though: the track where insurers will pay for at-home tests, and the track where you will soon be able to get tests mailed to your home.
So what's with insurers paying for at-home tests now?
Federal regulations now require private insurers to pay for up to eight at-home Covid-19 tests per person per month. Insurers long have paid for lab-processed PCR tests ordered by a physician, but what's new is that now people can get coverage for at-home tests without a prescription.
But that doesn't mean you should go grab eight tests (if you can find them) and use one because you want to go to Canada or because your employer requires a test before returning to the office. For one thing, Canada requires a negative PCR test processed by a lab, not a simpler at-home test. For another, insurers don't have to cover tests ordered by an employer just to prove its employees are healthy.
"We're really covering them for individual use: that means people who have been exposed and/or have symptoms," said Bob Wanovich, vice president of provider contracting at Highmark Blue Cross Blue Shield of Western New York.
How will my insurer pay for at-home tests?
At first it will be retro — really retro. The Biden administration gave insurers only five days to prepare for implementing the new insurance requirement, meaning they haven't had the time to pick preferred providers for the tests and set up simple systems where customers could pick up tests without paying a dime.
Insurers hope to do that, eventually, but for now, you'll have to pay for the tests yourself and submit claims with your insurer the old-fashioned way: by submitting a form and a receipt. Insurers will have to reimburse you for the full cost of the tests.
Eventually, though, people should be able to get tests free of charge from their pharmacy as long as they show proof of insurance.
"We're trying to figure out how we can make that happen electronically as seamlessly as possible," said Dr. Anthony J. Billittier IV, executive vice president and chief medical officer at Independent Health.
Does this mean my local pharmacy will have lots of tests in stock?
No. The availability of at-home tests has been maddeningly hit-and-miss since the Omicron wave started in December, and insurers said availability of the tests is likely to remain random over the next few weeks.
I'm on Medicare. Does that mean I can get free at-home tests from my pharmacy now, too?
Not if you are on traditional Medicare. The federal health program for seniors covers PCR and antigen tests ordered by a physician, and Medicare recipients can get free tests at community health centers and clinics, but traditional Medicare is not covering free at-home tests sold in stores and online. Some Medicare Advantage plans may cover those at-home tests, though, so it is best to check with your provider.
What if I'm on Medicaid?
State Medicaid plans will be required to pay for the over-the-counter tests.
I hear the government will be mailing out tests, too. How will that work?
Starting on Wednesday, Americans will be able to go to a website — COVIDTests.gov — and order up to four tests per residential address, no questions asked. Medicare recipients can order those tests, too, as can the uninsured. The administration also said it would set up a phone line that people without computer access can call to get their tests.
Biden administration officials said Friday the tests will be shipped out between seven and 12 days after the initial request. Some 420 million such tests are on order, with the government planning to eventually buy a billion at-home tests for free distribution by mail.
"This particular program is designed to ensure that Americans have at-home rapid tests on hand in the weeks and months ahead, as they have a need to test," a senior administration official said on a conference call with reporters on Friday.
And when do I need to get tested?
The Centers for Disease Control has said Americans should use the at-home tests if:
—They are experiencing symptoms of what could be Covid-19.
—They have been exposed to someone who has tested positive — although they should wait until five days after the exposure before taking the test.
—They are gathering indoors with people at severe risk of developing Covid-19 or who have not been vaccinated.
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