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At-home COVID tests to be covered by Michigan insurers. Here’s what to know.

covid test
Federal and state efforts to make testing more available have been constricted by limited supplies of test kits. (On The Run Photo / Shutterstock.com)

Jan. 18: Mailbox-bound: Free COVID tests now available for Michigan homes
Jan. 17: Omicron requires a better mask. How to choose one that’s best for you.
Jan. 14: For Michigan parents, a hellscape of nasal swabs, missed work and fury

Jan. 13: Beyond code red: Michigan hospitals wilt under double wave of COVID cases

Michigan insurers will be required to cover the costs of up to eight at-home COVID tests per member each month starting Saturday, under a new Biden administration initiative seeking to curb the cost of testing during omicron.

The new rule, which applies to both commercial insurance companies and group health plans, is the latest push by the Biden administration to make testing more affordable and help curb omicron’s spread. It also may help people to return to everyday lives sooner after being exposed to or infected with COVID.

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“The problem with COVID-19 in general — and even more so with the omicron variant — is (that) you can have it and be totally asymptomatic,” said Dr. Rebecca Schein, a pediatric infectious disease expert at Michigan State University.

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But she and others said just how often people will want or need to get tested will continue to vary by each person’s circumstances.

“If you know you're going to be going out into public or getting together with people, that would probably be a good time to test before, and then after, to make sure you didn't get COVID,” she said. 

In contrast, “if you know you're primarily staying home and working from home, you really probably only need to test if you get sick,” she said.

Recent federal and state updates in isolation and quarantine guidance recommend testing; that includes school guidance issued Monday by the Michigan Department of Health and Human Services. The Centers for Disease Control and Prevention recommends testing for anyone with symptoms or a “known exposure to someone with suspected or confirmed COVID-19,” regardless of vaccine status. The CDC also asks consumers to “consider” testing before social activities.

But in general there aren’t hard and fast rules about when to test, especially when testing supplies are limited, said Nick Derusha, executive director of the Michigan Association of Local Public Health,which represents the state’s local health departments.

The best use of the test, which frequently sells at pharmacies for more than $20 for a two-test kit, includes being able to determine if minor symptoms are COVID and should prompt isolation from others, he said.

“Everybody thinks they have allergies,” he quipped, referring to cases of individuals who are surprised to learn their symptoms are COVID-related and that they are contagious.

At-home tests have become increasingly scarce online and at retail outlets and lines at testing sites have lengthened in recent weeks as omicron-fueled COVID has surged in Michigan and across the country.

That’s all the more reason to make sure the timing is correct on when they are used. Testing too early after possible exposure, also called “panic-testing,” can result in false negatives, noted Ingham County Health Officer Linda Vail.

“The home test kits are incredibly valuable to have. We do need a better supply of them,” she said.

Under the Biden plan announced Monday, a family of four could get 32 free at-home tests. There is no limit at all if at-home tests are ordered or administered by a health care provider.

The frustration over limited testing may now be taken out on Michigan’s insurers, said Dominick Pallone, executive director of the Michigan Association of Health Plans, which represents most of the state’s largest insurers.

“(The federal) guidance doesn’t address testing supply problems,” he said. “Who do you think will get the complaints? It will be our call centers that will be lit up on (January) 15th when people can’t find the tests.”

Insurers, including Medicare and Medicaid, already cover COVID testing ordered by doctors and other clinicians, he noted.

But when it comes to at-home tests, insurers are concerned about fraud and price-gouging. And now they are scrambling to implement processes for covering millions of at-home tests that could be purchased beginning in four days, Pallone said.

In best-case scenarios, a consumer could go online or to walk into a pharmacy or retailer preferred by the insurer, pick up a test, and hand in their insurance card.

If insurers choose to set up convenient processes like that, the federal government will require insurers to reimburse customers up to $12 a test for any at-home tests purchased out-of-network — a limit that helps safeguard against price-gouging, Pallone said.

The federal government also provided a frequently-asked-questions link for free testing.  

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The over-the-counter COVID-19 diagnostic tests must be authorized, cleared, or approved by the U.S. Food and Drug Administration, which lists those tests here.

But insurers also have the option of putting in place a reimbursement plan, so that consumers would have to pay for tests up front and submit claims for reimbursement.

Medicaid and Medicare plans also cover tests, including at-home versions, that are ordered by a doctor. 

However, those enrolled in a Medicare Advantage plan should check with their plan to see if their plan offers coverage and payment for at-home over-the-counter COVID-19 tests not ordered by a doctor.

The announcement Monday added to an effort announced just before Christmas to distribute 500 million free tests to Americans via the U.S. Postal Service, but it’s not clear when those tests will ship to those who request them.

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