The Affordable Care Act requires health plans to cover the cost of over-the-counter COVID-19 diagnostic test kits without a prescription or letter of necessity from a health care provider. Self-funded and insured health plans must provide coverage for these tests without cost-sharing, without a prior authorization, and without any other medical management requirements. This requirement applies to tests purchased on or after January 15, 2022 while the COVID-19 public health emergency is in effect.
The Department of Labor issued frequently asked questions addressing the administration of coverage for COVID-19 testing. These FAQs confirm
- Plans have flexibility in establishing their protocol for providing tests to consumers, so long as one option for no out-of-pocket expenditure is provided.
- The government will not consider a plan to be out of compliance if it has established a direct coverage program but is temporarily unable to provide access to the program due to a supply shortage. If there is a supply shortage, the plan may limit reimbursement to $12 per test, or the full cost of the test, if lower.
- Plans are permitted to take reasonable steps to prevent, detect and address fraud and abuse.
- The rules apply to over-the-counter COVID-19 tests that are approved, cleared, or authorized for use by the FDA, can be obtained without a prescription, and completely used and processed without the involvement of a lab or health care provider.
- Individuals cannot be reimbursed for the cost of COVID-19 tests and submit the same expense for reimbursement from a flexible spending account plan.
The FAQs may be accessed by clicking here.
