For a lot of people in the United States, COVID testing is a nightmare right now.
Pharmacies and other retailers are frequently sold out of rapid tests. Lines for PCR tests are long. People are clogging up emergency rooms to get tested because they can’t find tests anywhere else. And yet a daily average of nearly two million tests have been conducted over the past two weeks, as the U.S. counts more than three quarters of a million cases per day and shatters previous hospitalization records.
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But there may be some relief coming soon.
Starting this week, the federal government will require private insurers to provide reimbursements for up to eight at-home rapid tests per person per month, or 32 tests for a family of four. The new rule is meant to reduce costs of the expensive tests, but the new guidance is just one of several related but distinct testing initiatives rolling out in the coming weeks.
Here’s what you need to know.
What’s the deal with reimbursements?
People with private insurance will now be able to get a limited number of rapid tests per month, either at no up front cost or through a reimbursement from their insurance companies.
As it stands now, at-home rapid tests—which are most accurate while a person actively has COVID symptoms—are much more expensive in the U.S. than they are in other countries. A two-pack of Abbott’s BinaxNOW rapid tests, for example, retails for $23.99 at Walgreens; the new guidance requires insurance companies to reimburse up to $12 per individual test.
“Under President Biden’s leadership, we are requiring insurers and group health plans to make tests free for millions of Americans,” HHS Secretary Xavier Becerra said in a statement. “By requiring private health plans to cover people’s at-home tests, we are further expanding Americans’ ability to get tests for free when they need them.”
Starting Saturday, people who have private health insurance or are covered by a group health plan will be able to get reimbursed for the cost of over-the-counter COVID tests or have those costs covered up front. The reimbursements will not be retroactive, meaning if you’re one of the many people who scrambled to find rapid tests during the holidays, you’re stuck with the cost unless your insurance company chooses to cover it. The new guidance does not include tests ordered by your doctor.
The HHS said that the administration’s new requirement “incentivizes insurers to cover these costs up front and ensures individuals do not need an order from their health care provider to access these tests for free.” The way the insurance companies and networks would do this is by setting up a list of preferred pharmacies or retailers where the cost of tests would be covered upfront.
But if you have to buy a test from a non-preferred pharmacy and then obtain a reimbursement later, you might be waiting for a bit. The health insurance reimbursement process is notoriously slow, so it could be several weeks before you get your money back.
Some in the insurance industry are already criticizing the move. “This is an unfunded mandate on insurers and consumers,” Michael Bagel, the director of public policy for the Alliance of Community Health Plans, told Politico Monday. “There’s nothing but barriers to get it set up in time. We have essentially 96 hours to get a preferred pharmacy list together and get the operational pieces in place.”
It’s unclear how the new regulations will affect the existing scarcity of rapid tests. The CEO of Abbott, which said in an October earnings call that its tests counted for 75 percent of retail sales in the U.S., recently said that his company is manufacturing up to 70 million tests this month, up from 50 million tests manufactured last month. (Though the CDC has said some rapid tests are less effective at detecting Omicron, a new real-world study, which hasn’t been peer-reviewed yet, found that the BinaxNOW test detects most cases of Omicron, the New York Times reported Wednesday.)
It’s also important to reiterate that this new guidance only applies for people who have private health insurance, which accounts for roughly 160 million people in the United States. Nearly 9 percent of the population, or 28 million people, did not have health insurance at any point last year, according to Census data.
State Medicaid and Children’s Health Insurance Programs (CHIP) are already required to cover the cost of COVID tests, while Medicare covers lab tests that are ordered by providers. Additionally, the DHHS says it’s also providing up to 50 million free tests for community health centers and Medicare-certified clinics.
Is this the same thing as the free tests?
No, it’s not.
When the reimbursement proposal was first announced last month, White House press secretary Jen Psaki was asked why the administration wasn’t taking the simpler route of putting free tests in the mail. Psaki responded by mocking the idea, asking: “Should we just send one [test] to every American?”
Psaki’s response was widely criticized, and a few weeks later, the administration abruptly reversed course, saying it would indeed distribute 500 million free at-home COVID tests.
But the details of this plan are not entirely clear. On Monday, the Department of Defense announced that it had awarded the first contracts to manufacture the tests to two companies, for a total of 27 million tests. This program will be rolled out over the course of several months, according to PBS Newshour.
White House Coronavirus Response Coordinator Jeffrey Zients said at a press briefing last week that the 500 million free tests will not affect the shortage of rapid tests, because the White House is ordering tests that aren’t on shelves right now.
“These are additional tests, and this is made possible by the fact that the FDA across the last few months have authorized many more rapid tests,” Zients said. “So, there’s a lot more capacity for rapid tests.”
Zients said then that the deliveries of the new tests would begin as soon as this week.
“We will set up a free and easy system, including a new website, to get these tests out to Americans,” Zients said. That website has not gone live yet.
Alright, so what else?
After testing sites in areas hit early by Omicron were overrun with hours-long waits to get tested, the White House announced that it would launch new federal testing sites to help places like New York City handle the surge. As of Jan. 5, the dozen federal testing sites in New York City which opened late last month had processed a total of 8,700 tests, Psaki said. Well over 100,000 people are getting tested every day in New York, according to city health data.
The administration announced last week that the federal government would open more federal testing sites in six states including Texas and Nevada, as well as more sites in Philadelphia and Washington, D.C.
The need is dire—an average of more than 750,000 people have tested positive daily over the past two weeks, according to CDC data, and 1.5 million positive cases from over the weekend were reported Monday. Vaccines and particularly boosters have held up well against severe disease and death, but the sheer magnitude of cases has resulted in the U.S. shattering the record set for hospitalizations last winter with no signs of slowing down.
“Obviously, this is an unprecedented action: to have a half billion tests bought by the U.S. government and distributed for free,” Zients said last week. “And we’ll continue to do more and more to increase access to testing, given the extreme demand that’s been driven by the transmissibility of Omicron.”
On Wednesday, the Biden administration announced that it would increase the number of tests it provides to schools by 10 million, including five million rapid tests and five million lab-based PCR tests. Despite the Omicron surge, 96% of schools are currently open according to a Wednesday press release from the White House announcing the move.
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