June 1, 2023

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How insurance companies – but not Medicare

Beginning Saturday, Jan. 15, insurance companies must cover up to eight take-home COVID tests per month for every person covered under their insurance plan.

President Joe Biden’s administration on Monday announced the requirement that insurance companies and group health plans cover the cost of over-the-counter, at-home COVID-19. But the order excludes Medicare beneficiaries.

Under the directive, for instance, “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,” according to a statement from the U.S. Department of Health and Human Services.

State Medicaid and Children’s Health Insurance Programs already are required to cover over-the-counter COVID tests. Medicare covers COVID-19 tests only when performed by a laboratory using a PRC or antigen test and when ordered by a medical provider.

U.S. Rep. Jan Schakowsky, an Evanston Democrat, said her office has received several calls from constituents concerned that Medicare beneficiaries were excluded from the directive. Several representatives are calling on HHS Director Xavier Becerra to extend the requirement to Medicare, she said.

“These are people who are vulnerable, that want to have a test and often can’t afford one,” Schakowsky said.

Under the directive, insurance companies can choose to have clients file a reimbursement claim after they’ve bought the test or provide the reimbursement at the time of purchase.



Blue Cross Blue Shield Illinois informs customers on its website that if over-the-counter COVID-19 tests are purchased using a pharmacy within their network, they should not have to submit a separate claim.

“Members can use the same broad networks used for COVID-19 vaccines to request tests. Claims will be submitted directly from the pharmacy to Blue Cross Blue Shield Illinois,” according to the company website.

Walgreens and CVS are listed among the large pharmacies the company has partnerships with.

In contrast to what appears Blue Cross Blue Shield Illinois is advising their holders, Walgreens directs customers to use their receipt to seek reimbursement with their insurance company.

“At this time, customers are able to purchase an over-the-counter test and use their receipt to seek reimbursement. We ask for patience as we make this complex process as smooth as possible. We remain committed to providing vaccinations and testing services and products that are critical to helping protect our communities,” according to Walgreens’ website.



Under the plan, the government will reimburse insurance carriers up to $12 per individual test.

Tests must be approved by the U.S. Food and Drug Administration.

For information, go to www.covid19.ncdhhs.gov for the latest lists on approved tests.

Insurance carriers will not be required to have a doctor’s note for the over-the-counter test to be purchased under this plan, nor will the purchase require “any cost-sharing requirements such as deductibles, co-payments or coinsurance, prior authorization, or other medical management requirements.”