In a significant move to broaden access to COVID-19 diagnostic testing, the Biden Administration has clarified and expanded the requirements for health insurance coverage. Building upon President Biden’s Executive Order signed in January 2021, new guidance has been issued to ensure that private health plans and issuers remove barriers to COVID-19 diagnostic tests and vaccinations. This means that millions of Americans can now access COVID-19 testing without worrying about cost sharing, even if they are asymptomatic and have no known exposure to the virus.
This updated guidance, released by the Centers for Medicare & Medicaid Services (CMS) in collaboration with the Departments of Labor and the Treasury, directly addresses concerns and questions surrounding coverage for asymptomatic individuals. Previously, there was ambiguity about whether health plans were required to cover tests for those without symptoms or known exposure. The new clarification states unequivocally that group health plans and issuers must generally cover COVID-19 diagnostic tests for all covered individuals, regardless of symptoms or exposure status.
This policy shift is particularly impactful as it eliminates the use of medical screening criteria to deny coverage for COVID-19 diagnostic tests for asymptomatic individuals. For instance, someone wanting to take a COVID-19 test before visiting elderly relatives or attending a social gathering can now do so without incurring out-of-pocket expenses. This proactive approach to testing is crucial for controlling the spread of the virus and ensuring public health safety. Crucially, this coverage must be provided without cost sharing, prior authorization, or other medical management requirements that could create obstacles to access.
The guidance also reinforces that point-of-care COVID-19 diagnostic tests, as well as tests administered at state or locally managed testing sites, are fully covered under these provisions. This comprehensive coverage ensures that individuals have access to testing in various settings, further simplifying the process and encouraging widespread testing.
For healthcare providers, the announcement also provides important information regarding reimbursement. The guidance highlights avenues for providers to seek federal reimbursement for the costs associated with administering COVID-19 diagnostic testing or vaccinations to uninsured individuals. One key resource is the Provider Relief Fund program, specifically the HRSA COVID-19 Uninsured Program. This program has already played a vital role in reimbursing providers for the testing and treatment of uninsured individuals, disbursing over $3 billion to date. As vaccination efforts continue to scale up across the nation, this program is also expected to cover vaccine administration costs for the uninsured. The administration is actively seeking feedback on strategies to further connect uninsured individuals with providers participating in this fund, aiming to maximize access to care for all.
This latest guidance from CMS builds upon previous policies and clarifications issued through interim final rules and FAQs. It represents a continued effort by the Biden administration to ensure comprehensive coverage for COVID-19 related healthcare services during the ongoing public health emergency. By removing financial barriers to testing, particularly for asymptomatic individuals, the administration aims to promote early detection, reduce transmission rates, and ultimately protect public health.
For more detailed information on vaccine coverage and reimbursement requirements for issuers and providers, CMS offers a dedicated toolkit. Further resources and the full text of the guidance are available on the CMS website and the Current Emergencies Website. Updates and news from CMS can also be accessed through their newsroom, email sign-up, and social media channels.
