Contact 6 tests insurance coverage, at-home COVID tests

It’s now more affordable for Americans to test themselves for COVID-19 at home. On Jan. 15, the federal government began requiring insurance companies cover the cost of at-home tests.

If you have private insurance or a group health plan, you can get coverage of up to eight tests per person per month. A family of four can get up to 32 tests a month covered.

"It’s a good tool if you have symptoms or you are exposed to someone. To have it handy," said Marwa Bakr at Infinity Pharmacy in Milwaukee.

On Wednesday, cars were lined up for COVID-19 tests in Infinity Pharmacy’s drive-thru. The pharmacy has been getting many calls about whether it has at-home tests in stock. When Contact 6 visited on Wednesday, the pharmacy had no inventory but was expecting another shipment.

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The government is incentivizing insurers to set up networks of preferred pharmacies and retailers, so consumer can get their tests covered up-front, instead of keeping the receipt and submitting a claim later for reimbursement.

"The key is whether you’re going to be reimbursed after the fact, or you’re going to have it covered at the pharmacy counter," said Sarah Smith, director of public affairs for the Office of the Commission of Insurance (OCI).

Sarah Smith

So, how does getting the insurance coverage work in practice?

Contact 6 reporter Jenna Sachs visited her insurance provider’s website and found its preferred retailer. Then, she visited the store’s pharmacy on Wednesday to find out how smoothly the process would go.

Sachs found a handful of boxes left on a shelf and brought them to the pharmacy counter, where she was told she was the "first person" to seek coverage. Twenty minutes later, Sachs was approved for full-coverage, and left the store with four tests valued at about $40 and a bill saying she owed $0. Overall, the process went smoothly.

"Each swab can be reimbursed up to $12, that’s the requirement," said Smith.

For consumers who can’t visit a preferred pharmacy or retailer, insurers are posting reimbursement forms to their websites. But, while the insurance coverage is one thing, access to at-home tests is another.

"They go really fast," said Bakr. "Once I receive my shipment it doesn’t last a few hours, and then it’s gone."

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Contact 6 hit the stores again looking for at-home tests. Sachs visited four Milwaukee retailers and found tests on the shelves at every location, though sometimes in limited supply. Store employees told her that inventory remained tight.

Bakr says Infinity Pharmacy doesn’t mind calls about whether it has at-home tests in stock. When the tests do arrive, she says her staff is ready to process insurance claims.

"I have a few customers who called me and said, "I checked with the insurance and you are in-network," said Bakr.

If an at-home test costs more than $12, the consumer may have to pay the difference, depending on their insurance plan. Tests bought prior to Jan. 15, 2022 are not eligible for reimbursement.

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