Washington (February 17, 2023) – Senator Edward J. Markey (D-Mass.), Chair of the Senate Health, Education, Labor and Pensions Subcommittee on Primary Health and Retirement Security, and his colleagues Senators Elizabeth Warren (D-Mass.) and Martin Heinrich (D-N.M.) today sent a letter to the Matt Eyles, President and CEO of American Health Insurance Plans (AHIP) calling on the trade association’s membership to maintain coverage of free, at-home COVID-19 tests, even once the formal federal COVID-19 public health emergency comes to an end. The senators also express concern that health insurance providers across the country are not complying with their current legal obligations to cover at-home COVID-19 tests during the ongoing public health emergency and have added expensive, burdensome reimbursement policies for these tests, which have hindered access. At the onset of the COVID-19 pandemic, Congress passed the Families First Coronavirus Response Act
, requiring insurers to cover testing during the public health emergency, and the Biden administration later issued guidance requiring private health insurance plans to cover eight free over-the-counter home tests per covered individual per month. Unfortunately, over a year after this guidance went into effect, insurers still do not provide direct coverage of tests at pharmacies and retailers, forcing their enrollees to pay upfront for their tests and face unnecessary, time-consuming and often frustrating reimbursement paperwork that has, in some cases, resulted in denied claims.
“Unnecessary testing barriers hurt all low-and-middle income families, especially disabled, immunocompromised, and elderly Americans,” the senators wrote in their letter to AHIP’s President and CEO Matt Eyles. “Having free and convenient access to COVID-19 tests, particularly at-home tests, helps people who are most at risk for severe COVID-19 avoid hospitalization and death. It allows them to test often, including repeatedly after exposure, and may provide them with greater access to antiviral treatment, such as Paxlovid, which is available only within five days of symptom onset.”
“For many Americans navigating the health insurance landscape, confusion, administrative burden, and cost are not new,” the senators continued. “But they should not have to face and overcome these obstacles when they seek COVID-19 tests in an attempt to keep themselves, their families, and their communities safe. While the public health emergency may end, the risks associated with COVID-19 have not. No one should ever be forced to choose between health and financial security.”
In the letter, the lawmakers called on insurance companies to respond to the following questions by March 3, 2023:
- Will AHIP commit to encouraging and supporting its members to continue covering at-home COVID-19 tests, without medical management or cost-sharing, after the expiration of the COVID-19 public health emergency?
- What information has AHIP provided to its members about their obligations under statutory requirements and the January 15, 2022 guidance relating to at home COVID-19 tests?
- What steps has AHIP taken to help its members implement the January 15, 2022 guidance? When did AHIP begin to help its members implement coverage requirements for at-home COVID-19 tests?
- What information has AHIP provided to its members about establishing direct coverage networks to provide COVID-19 tests free at the point of service? Why are some AHIP members not offering direct coverage plans?
- What information has AHIP provided to its members about establishing online reimbursement submissions through a member’s website? Why do any AHIP members still require mail or fax submissions of reimbursement requests?
- What information has AHIP collected from its members about the number of denials of coverage when upfront payment and reimbursement is required, the length of time for reimbursement, and the number of denials of resubmissions and appeals?
- How is AHIP working with its members to resolve reimbursement denials for claims submitted after the January 15, 2022 guidance took effect?
- Will AHIP be providing information to its members on steps for approving claims previously denied wrongfully?
- Will AHIP be providing information to its members about their obligations to approve claims for tests purchased between January 15, 2022 and May 11, 2023, even if the claims are received after the end of the public health emergency?
- What information has AHIP provided to its members about the end the COVID-19 public health emergency?
- Has AHIP provided any guidance to its membership to continue coverage of at least eight at-home tests per covered individual after the end of the public health emergency?
- What information has AHIP collected from its members about their plans to cover at-home COVID tests at no or low-cost after the end of the public health emergency?
Senator Markey has consistently advocated on behalf of Americans suffering as a result of the COVID-19 public health crisis. As the Omicron variant continued to spread in January 2022, Senator Markey wrote
a letter to the Federal Trade Commission calling on COVID-19 test manufacturers and retailers to ensure Americans have access to affordable and trustworthy at-home rapid testing kits. In May 2022, Senators Markey, Duckworth (D-Ill.), and Kaine (D-Va.) urged
public health officials to better prioritize the needs of the populations at highest risk of severe illness from COVID-19 including seniors, people with disabilities, and the immunocompromised in their ongoing response to the public health emergency. Specifically, the letter called on the Biden administration to consult high-risk communities, publicly report on hospital-acquired COVID-19 infections and deaths, clarify mask guidance for health care facilities, and explore options to make high-quality masks available to high-risk groups.