Starting May 11, payers will no longer have to cover any COVID-19 polymerase chain reaction (PCR) testing with no cost sharing for members, or reimburse members who purchase over-the-counter COVID tests. It’s one of many health care policy changes dictated by the planned end of the federal COVID public health emergency (PHE) on that date. Experts tell AIS Health, a division of MMIT, that the transition will likely cause PCR test prices to fall.
The Families First Coronavirus Response Act and the CARES Act, both passed in 2020, require private health insurers to cover coronavirus tests, with no cost sharing, as well as any services associated with those tests (such as administrative fees), per an expansive reading of both laws implemented by the Biden administration starting in 2021. During 2020, the incumbent Trump administration had required coverage only for “medically necessary” tests ordered by a practitioner. In addition, the Biden administration starting in January 2022 required health plans to reimburse members for up to eight at-home tests per month.