Biden announces ‘free’ at-home Covid tests – but there’s a catch

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Americans with private medical insurance will be able to have the costs of at-home Covid-19 testing kits reimbursed by their insurers as part of a series of actions from Joe Biden’s administration to bolster the US against the coronavirus pandemic as the public health crisis enters a third year.

The new policy will not cover upfront costs for such rapid at-home kits, which can range from $10 to $25. Instead, the roughly 150 million Americans with private insurance plans must file claims with their insurance providers to be reimbursed for the cost of at-home testing. Private insurers already cover in-office tests.

The policy likely will not take effect in mid-January 2022, and it will not be retroactive, a senior administration official told reporters on 1 December. Americans with public insurance through Medicare and Medicaid programmes are “not covered by this particular action,” the official said.

The policy also does not cover out-of-pocket costs for millions of Americans who are uninsured; in 2020, roughly 28 million people did not have any health insurance coverage at any point in the year, according to the US Census Bureau.

Availability and access to PCR testing and rapid tests at public sites and clinics also varies widely across the US, and in-demand at-home kits face supply shortages and come with relatively high prices compared to other countries where tests are cheap or free and widely available.

Asked why the government does not subsidise the costs of tests and hand them out freely, White House press secretary Jen Psaki told reporters on 2 December that “we believe our process for evaluating tests is the gold standard,” pointing to eight tests approved by the Food and Drug Administration, and widely available testing at public health sites and clinics across the US

The US is boosting supplies of 50 million at-home tests to be “distributed through key community sites, such as health centers and rural clinics,” according to the White House. The US government supports roughly 20,000 locations where Americans can get tested for free.

Mr Biden’s latest suite of Covid-19 policies – including new rules for travel, a new booster-shot campaign, and global vaccination support – follows the emergence of the omicron variant as the US braces for a potential winter surge of infections.

Experts have argued that widely available rapid testing is a key component – along with face coverings and vaccines – to control infections.

In a November report, the Kaiser Family Foundation pointed to the cost and lack of insurance coverage for at-home tests as barriers to expanding such testing in the US, as rapid testing has become integral to school reopenings and the workplace.

“Insurance reimbursement for at-home tests will expand access and help to slow the spread the virus,” Larry Levitt, executive vice president for health policy with Kaiser Family Foundation, said on Twitter following the administration’s announcement. “But, it is cumbersome compared to places like the UK, where tests are free online and in pharmacies. Another example of our fragmented health system at work.”

He added: “Insurance reimbursement for at-home Covid tests is hardly the most efficient way to give people better access to affordable testing. But, it is something the Biden Administration can do quickly with existing authority, and quick action is important right now.”

Roughly 66.5 per cent of insured Americans rely on private insurance plans, with 54.4 per cent relying on health plans provided by their employers, according to the US Census Bureau.

Millions of Americans are also considered underinsured, with out-of-pocket costs for their care exceeding 10 per cent of their income, or with deductibles that are more than five per cent of their income.

An estimated 3.4 million Americans would be eligible for health insurance through the White House-backed Build Back Better legislation, which passed the US House of Representatives last month. It faces a tough hurdle in a divided Senate.