Gov. Phil Scott and Department of Financial Regulation Commissioner Michael Pieciak recently issued an emergency rule requiring that insurance cover the costs of COVID-19 antigen at-home tests, or rapid tests.
The emergency rule covers approximately 140,000 Vermonters who purchase commercial insurance in Vermont's markets as well as the Vermont Education Health Initiative. The rule requires health insurers to pay for FDA-authorized COVID-19 antigen tests without cost-sharing for home use.
"Vermont has led the nation in testing, but we must continue to adapt and improve our strategies as we move forward," said Gov. Scott. "At home tests will increasingly be an effective and widely used tool for managing the virus, and expanding access is a priority for my team."
Vermont was one of the first states to require commercial insurers to cover the costs of COVID-19 PCR testing and continues to be one of the only states to eliminate out-of-pocket insurance costs for those requiring treatment for COVID-19.
Once fully implemented, those covered by the rule will be able to obtain an at-home test through a pharmacy without upfront costs. Instead, at-home tests will be billed through pharmacy benefit and the pharmacy will then seek reimbursement. Those purchasing at-home tests outside a pharmacy setting, though, will have to submit a claim to their insurer for reimbursement.
All covered individuals will need to file a claim through their insurance until the pharmacy benefit is fully implemented, which will probably take a few weeks.
"Eliminating financial barriers to COVID-19 testing and treatment has been in important component of Vermont's pandemic response," said Pieciak. "Making COVID-19 testing free and accessible helps limit the spread of the virus by identifying positive cases quickly, which is particularly important as we continue through the holiday season."
Although Vermont lacks authority to extend the emergency rule to self-insured plans, the State is encouraging those plans to voluntarily follow the rule in anticipation of new federal regulations recently announced by the Biden Administration. The University of Vermont Health Network, Vermont's largest self-insured plan, has indicated it intends to follow the emergency rule and the State of Vermont encourages other employers who self-insure to do the same.
To help maintain supply of at-home test kits for everyone, coverage is limited to eight test kits per person per month. Health insurers must process and reimburse appropriate claims for tests described in this emergency rule retroactively for tests purchased on or after December 1, 2021.