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'Bit more hope' | Pearland father among 200 million Americans whose insurance will cover cost of 8 at-home COVID tests

“If you’re allowing people to get reimbursed for that cost, then you’re probably going to see demand spike for those tests,” Fidel Martinez said.

HOUSTON — As the highly contagious omicron COVID-19 variant spreads throughout the Greater Houston area, demand for testing is rising.

Harris County and the city of Houston continue to expand mass testing sites that offer free PCR or antigen testing.

RELATED: Where to get a free COVID-19 test in the Houston area

People who are unable to get to one of several public testing sites are searching for at-home COVID-19 test kits. But demand for the rapid test kits are wiping out supplies in stores and online. The individual test kits can also put a financial strain on families needing to buy several kits.

In an effort to ease one of many financial burdens associated with the global pandemic, the Biden Administration will begin requiring private health insurance companies to cover the cost of up to eight at-home tests per individual each month.

RELATED: Free at-home COVID tests: Reimbursement details, monthly limits

The program, which starts Saturday, Jan. 15, will help recent Prairie View A&M graduate Jane Ejeme Olear.

“So, I had to buy a lot of at-home tests. And I was very shocked,” Olear said about the cost of each test kit -- which can range from $10 for a single test to $40 for a two-pack kit.

Olear and Pearland father Fidel Martinez both said they’ve spent a couple hundred dollars on at-home COVID testing in the last few months.

“It could end up being quite a bit. Because if you end up doing one test per week, over the course of a month, family of four,” Martinez said, “that’s pretty intense.”

In a press release from the U.S. Department of Health and Human Services, the Biden Administration explains how the reimbursement program will work:

The new coverage requirement means that most consumers with private health coverage can go online or to a pharmacy or store, buy a test, and either get it paid for up front by their health plan, or get reimbursed for the cost by submitting a claim to their plan.

Beginning January 15, 2022, individuals with private health insurance coverage or covered by a group health plan who purchase an over-the-counter COVID-19 diagnostic test authorized, cleared, or approved by the U.S. Food and Drug Administration (FDA) will be able to have those test costs covered by their plan or insurance. Insurance companies and health plans are required to cover 8 free over-the-counter at-home tests per covered individual per month. That means a family of four, all on the same plan, would be able to get up to 32 of these tests covered by their health plan per month. There is no limit on the number of tests, including at-home tests, that are covered if ordered or administered by a health care provider following an individualized clinical assessment, including for those who may need them due to underlying medical conditions.

“Under President Biden’s leadership, we are requiring insurers and group health plans to make tests free for millions of Americans. This is all part of our overall strategy to ramp-up access to easy-to-use, at-home tests at no cost,” said HHS Secretary Xavier Becerra. “Since we took office, we have more than tripled the number of sites where people can get COVID-19 tests for free, and we’re also purchasing half a billion at-home, rapid tests to send for free to Americans who need them. 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.”

Over-the-counter test purchases will be covered in the commercial market without the need for a health care provider’s order or individualized clinical assessment, and without any cost-sharing requirements such as deductibles, co-payments or coinsurance, prior authorization, or other medical management requirements.

As part of the requirement, the Administration is incentivizing insurers and group health plans to set up programs that allow people to get the over-the-counter tests directly through preferred pharmacies, retailers or other entities with no out-of-pocket costs. Insurers and plans would cover the costs upfront, eliminating the need for consumers to submit a claim for reimbursement. When plans and insurers make tests available for upfront coverage through preferred pharmacies or retailers, they are still required to reimburse tests purchased by consumers outside of that network, at a rate of up to $12 per individual test (or the cost of the test, if less than $12). For example, if an individual has a plan that offers direct coverage through their preferred pharmacy but that individual instead purchases tests through an online retailer, the plan is still required to reimburse them up to $12 per individual test. Consumers can find out more information from their plan about how their plan or insurer will cover over-the-counter tests.

State Medicaid and Children’s Health Insurance Program (CHIP) programs are currently required to cover FDA-authorized at-home COVID-19 tests without cost-sharing. In 2021, the Biden-Harris Administration issued guidance explaining that State Medicaid and Children’s Health Insurance Program (CHIP) programs must cover all types of FDA-authorized COVID-19 tests without cost sharing under CMS’s interpretation of the American Rescue Plan Act of 2019 (ARP). Medicare pays for COVID-19 diagnostic tests performed by a laboratory, such as PCR and antigen tests, with no beneficiary cost sharing when the test is ordered by a physician, non-physician practitioner, pharmacist, or other authorized health care professional. People enrolled in a Medicare Advantage plan should check with their plan to see if their plan offers coverage and payment for at-home over-the-counter COVID-19 tests.

“If you’re allowing people to get reimbursed for that cost, then you’re probably going to see demand spike for those tests,” Martinez said.

The results of at-home COVID test are not tracked by health departments, though the financial freedom to consider another option might lessen the backlog at test sites across Houston.

Check out more COVID stories on the KHOU 11 YouTube channel:

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