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With limited lead time, Mass. private health insurers create new COVID-19 test reimbursement systems

Boxes of iHealth COVID-19 rapid test kits. (Jay L. Clendenin/The Los Angeles Times via Getty Images)
Boxes of iHealth COVID-19 rapid test kits. (Jay L. Clendenin/The Los Angeles Times via Getty Images)

Starting this week, there are several new ways to get rapid COVID-19 tests. You can order tests online through a government website, or get them covered by a private health insurer.

The new programs are part of President Biden's bid to make testing more accessible and affordable. But a tight timeline means many insurers are still working out exactly how to comply with the administration's requirement, which will last for the duration of the federal public health emergency.

Beginning on Wednesday, people can request up to four free rapid tests per residential address to be delivered through the mail. Orders will be placed at COVIDTests.gov or through a phone number. Tests will typically ship within seven to 12 days. Priority will be given to communities that are particularly vulnerable and have been disproportionately hard-hit by the virus.

As of Saturday, private health insurers are required to cover eight at-home COVID tests per member per month. In many cases there are two test kits per box, meaning four boxes will be covered.

While the federal government says it's "strongly incentivizing" insurers to arrange a system where people can get tests with no out-of-pocket costs, that isn't likely to happen — at least initially — in Massachusetts. Instead, for many insurers, the system is beginning as a reimbursement model. That means individuals front the cost and get repaid later.

Both Tufts Health Plan and Harvard Pilgrim Health Care are telling members to save receipts for FDA-approved at-home COVID tests purchased on or after Jan. 15. Both providers say they will have a form online by Jan. 19 that members can print and submit for reimbursement.

"We will continue to work to determine how best to implement this new federal requirement, with a focus on simplifying the process for our members," said Kathleen Makela in a statement. Makela is a spokesperson for Tufts Health Plan and Harvard Pilgrim Health Care, which share a parent company.

"Although not mandated by the federal requirements, we are also developing a coverage policy for over-the-counter FDA-approved, at-home COVID-19 tests for our Medicare members, and working with state officials in Massachusetts and Rhode Island on covering the tests for those enrolled in our Medicaid plans," she added.

Blue Cross Blue Shield of Massachusetts has a similar reimbursement model, with an initial submission form available on its website. That form will be replaced on Jan. 23 once the insurer develops a new one.

A spokesperson pointed out that private insurers were given just five days between federal rules being released and the program starting.

"We haven't had a great deal of time to implement," wrote Gregory Winter, a spokesperson for Blue Cross Blue Shield of Massachusetts, in an email. "We are working on creating a national preferred pharmacy network that will initially include over 20,000 retail pharmacies. In the near future, when the network is up and running, Blue Cross members will be able to go to a preferred pharmacy, such as CVS or Walmart, and obtain certain authorized tests for $0."

Winter also noted that members will be asked to attest that the test is for their personal use and will not be resold. Tests used for employment purposes will not be reimbursed, he said.

However, the entire reimbursement scheme relies on people being able to find rapid COVID tests to buy either online or at their local pharmacy. As the insurer Aetna says on its website: "Just keep in mind that the Omicron variant has created an overwhelming demand for [over-the-counter] COVID-19 tests in many communities, so supplies may be limited."

Related:

Gabrielle Emanuel Twitter Senior Health and Science Reporter
Gabrielle Emanuel is a senior health and science reporter for WBUR.

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