As of January 15, 2022, the cost of over the counter Covid-19 tests has to be covered by health plans. Even if they are obtained without the involvement of a health care provider.
The FAQ guidance issued by the COL, HHS and Treasury Department do not require tests to be covered if they are not for individualized diagnosis (such as tests for employment).
· Requiring individuals to purchase a test and submit a claim for reimbursement rather than providing direct coverage to sellers.
· Providing direct coverage through pharmacy networks or direct-to-consumer shipping programs and limiting reimbursements to other sources (the actual cost of the test, or $12, whichever is lower).
· Setting limits on the number of frequency of OTC Covid-19 tests that are covered (no less than 8 tests per month or 30-day period).
· Taking steps to prevent, detect and address fraud and abuse.
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