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How Your Employees Can Get Free COVID Test Kits

While COVID-19 cases start rising again, more people are once again likely to contract the coronavirus — and that usually involves getting tested. But for employees in your group health plan, they have many options for obtaining a test with no out-of-pocket costs.

Under an executive order issued by President Biden, employees in a group health plan are eligible to receive COVID-19 at-home test kits with no cost-sharing, copay, coinsurance or deductible. Additionally, most health plans are also covering tests performed at hospitals, clinics and pharmacies.

While we told you about these new rules a few months ago, it’s likely that a good many of your employees don’t know about it. With that in mind, you may want to disseminate information to them about how they can be reimbursed by their insurer for COVID-19 tests they purchase.

Here’s what your employees need to know:

Steps for reimbursement

Procedures will vary from insurer to insurer, but the order requires that health insurance carriers reimburse members for up to eight tests a month and no doctor’s order, prior authorization or prescription is required. This applies to any tests they purchased on or after Jan. 15, 2022.

Most health plans have preferred pharmacies that they urge their enrollees to go to for their take-home COVID-19 tests. In these instances, the plans will typically cover the cost at the point of sale so that the health plan member doesn’t have to pay out of pocket.

Covering costs upfront eliminates the need for members to submit reimbursement forms.

However, if they go to a non-network pharmacy or drugstore or purchase a kit online, the health insurer is still required to reimburse them for a test up to $12 (or the cost of the test if it’s less than that).

In these cases, the employee will have to pay for the test upfront and then seek reimbursement from their health insurer.

You can contact your health insurer for information and resources for how your staff can receive reimbursement. Most insurers have published materials to make it easier for your workers to access COVID-19 tests with no cost to them.

Typically, to be reimbursed for at-home test kits, members must submit the reimbursement form and a receipt that shows proof of purchase, which should include the name of the retailer, including the street address, or, if bought online, the website address; date of purchase; UPC code for the at-home test kit; and the cost of the kit.

The order that health plans cover these tests with no out-of-pocket costs for their enrollees will sunset when the federal public health emergency is declared over.

On-site tests

Health plans are also covering the cost of tests that are administered at pharmacies or in hospital settings after either a doctor ordered a test or if the person was exposed to someone who had COVID-19.

Like at-home tests, insurers will cover the costs of these tests regardless of if they are received in-network or from an out-of-network provider or pharmacy.

The types of COVID-19 tests health insurers currently cover are:

  • Individual testing with or without symptoms,
  • Testing ordered by a health care provider,
  • Testing for contact tracing, known or suspected exposure, and
  • Testing before or after travel (COVID-19 screening tests for domestic travel are usually covered by most plans, but enrollees should not expect their plan to cover any testing they do abroad).

After the public health emergency ends, however, it’s likely most insurers will stop covering tests obtained out of network.


Gen Z, Millennials Grow Disillusioned with Their Health Insurance

Surprise bills and billing errors are driving growing dissatisfaction among Millennials and Gen Zers with their health insurance, a new study has found.

HealthCare.com‘s “2022 Medical Debt Survey” found that about one in four Gen Zers and Millennials with medical debt skipped rent or mortgage payments because of their debt. That’s compared with 21% for Gen Xers and 12% for baby boomers.

The study reflects the increasing burden that health insurers’ policies for out-of-network care and higher deductibles are having on Americans, particularly those who are the most recent entrants to the job market. Since they typically earn less than those who have more experience, Millennials and Gen Zers are more susceptible to hardships if they receive unexpected bills.

To help these generations of workers, consider offering them educational sessions on how to choose health plans, coupled with training on how to avoid unexpected health care bills by going to in-network providers, and how to shop around in advance for scheduled procedures.

Already facing outsized medical cost hits, an increase in billing mistakes and surprise bills is contributing to a dim view of health insurance among Millennials and Gen Zers. In fact, 68% of Gen Zers who have health insurance but still incurred medical debt said their health insurance plan didn’t cover the service they received (or they received services out-of-network).

Additionally, the study found that:

  • 39% of Millennials are unsatisfied with their health insurance options.
  • About three in 10 Gen Zers (31%) and Millennials (27%) with medical debt believe that their debt is the result of a billing error.
  • 48% of Millennials have received a surprise medical bill.
  • 35% of Millennials have received a mistaken bill or had a claim denied.
  • 26% of Millennials have medical debt.

Affordability of health insurance is also a big consideration. Some 54% of Millennials say their health insurance is somewhat or very affordable.

Millennials are also using their health insurance benefits differently than prior generations:

  • 48% say they have used an urgent care center in the past. These visits can often cost more than a typical visit, but not as much as going to the emergency room.
  • 35% have used telehealth services for physical ailments.
  • 26% have sought mental health services through telehealth platforms.
  • 27% have used discount pharmacy apps.

The takeaway

The key to improving your younger generation workers’ understanding of their health benefits and how best to use them is through education. It starts with perhaps having a special session during each open enrollment focusing on what type of health plans are best suited for their generation.

If you offer high-deductible health plans, educate your staff on the importance of putting money aside in health savings accounts so they have money to pay for those unexpected expenses.

They should also be educated in how to use their health insurance to avoid larger costs, and the ramifications of using providers not in their health plan’s network. The education should also cover the costs of going to an emergency room compared to scheduling an appointment with their doctor or going to an evening clinic at their office.


Employers See Staff Drop Coverage, Sign Up on Exchanges

A surge in federal government subsidies has led many people to drop their employer-sponsored health insurance and instead seek out coverage on government-run Affordable Care Act exchanges, according to a report by the Kaiser Family Foundation.

Subsidies, which were increased substantially by COVID-19 stimulus legislation, are so large for some who purchase coverage on exchanges that many of them can access ACA plans that cost just a few dollars a month, depending on their income, according to the report.

But the defectors are likely to return to their employer-sponsored health plans as the subsidies are set to expire at the end of 2022, which will likely make their employer-sponsored coverage more affordable. Only individuals who work for organizations that have fewer than 50 full-time workers have been able to make this switch and enjoy low premiums.

Individuals who work for employers that are large enough to qualify as “applicable large employers” are barred from jumping into the individual market as they do not qualify. They instead are required to sign up for their employer’s group health plan or forgo coverage altogether. 

What’s happening

The American Rescue Plan, which took effect in 2021, expanded and increased tax credits available for purchasing coverage on federal- and- state-run exchanges through the end of 2022. Before that, the law limited eligibility for premium tax credits through the federal and state exchanges to households whose income is from 100% to 400% of the poverty level.

The stimulus bill removed that cap for 2021 and 2022, as well as limit the amount anyone pays in premiums to 8.5% of their income as calculated by the exchange. That means someone who made 450% of the poverty level would receive a premium tax credit that would reduce the premium they pay to 8.5% of their income. In those cases, the total tax credit runs into the thousands of dollars for the year.

The premium tax credit is based on factors that include income, age and the benchmark “silver” plan in a person’s geographic area. The amount they qualify for is basically advanced to them over the course of the year via reduced premiums. If they choose a bronze plan, they can greatly reduce their share of the premium.

These effects have been most pronounced for lower- to middle-income and single-income households. 

However, the premium tax credit comes to an end on Dec. 31, 2022, and the premium tax credit regime reverts to the prior one.

How to handle next open enrollment

It’s advisable that you assess your health insurance enrollment and see if any of your staff dropped their group health coverage and signed up for individual coverage on the exchange. If you are an applicable large employer, that should not have happened for the reasons mentioned above.

If you are a smaller employer not subject to the ACA, you should reach out to any employees who signed up on an exchange and inform them about the impending premium tax credit changes. Advise them that reverting to the old premium tax credit rules is likely to result in their share of the premium increasing substantially.

Remind them that your annual open enrollment is their only chance to secure group health coverage and that they should review their marketplace coverage as early as possible. If they wait too long and miss your open enrollment deadline, they could be stuck with the more expensive marketplace coverage.


Measure Would Cap Insured Out-of-Pocket Cost of Insulin at $35

The U.S. House of Representatives has passed legislation that would cap the out-of-pocket cost of insulin at $35 a month for people with group or private health insurance.

While the measure still has to face a vote in the Senate, it has broad backing after the cost of insulin has skyrocketed in recent years. People who used to pay less than $100 a month for the vital medication are sometimes paying more than $1,000, depending on their health insurance coverage.

More than 37 million Americans have diabetes, and this legislation could be a game-changer for the estimated 7 million who have to take insulin to control their condition.

In the past decade, the cost of insulin has tripled in the United States, with average out-of-pocket costs rising to about $666 a month. But some people need specific brands and can pay more than $1,000 a month for their brand.

For example, David Tridgell, a Minneapolis endocrinologist, wrote an op-ed in The Washington Post citing the costs typical diabetics face:

  • Patients with Type 1 diabetes tend to use two or three vials of insulin per month. At the current cost of one vial of Humalog 50/50, these patients would spend $780 to $1,170 on their insulin every month.
  • Type 2 diabetes patients sometimes need six or more vials a month, which would run up the costs to $2,341 or more every month.

It can be especially costly for individuals enrolled in high-deductible health plans, in which enrollees have to pay the list price for their insulin until their deductible is met. This could mean thousands of dollars out of pocket before the insurer will cover the drug. Because of the soaring costs, many people report reducing dosages or rationing to make their insulin last longer.

Diabetes can lead to other serious health complications, including kidney failure, heart disease and loss of vision.

How it would work

HR 6833 would bar private health insurers, health plans and self-insured employers from applying a deductible on insulin and require that diabetics pay no more than $35 or the amount equal to 25% of the negotiated price of the selected insulin product, whichever is lower.

For no more than $35 a month, the Affordable Insulin Now Act would require private group or individual plans to cover both vial and pen dosage forms and any of the following insulin types:

  • Rapid-acting,
  • Short-acting,
  • Intermediate-acting, and
  • Long-acting.

Medicare Part D plans, Medicare stand-alone drug plans and Medicare Advantage drug plans would be required to charge no more than $35 for whichever insulin products they cover in 2023 and 2024, and for all insulin products beginning in 2025.

HR 6833 passed on a vote of 232 to 193, with 12 Republican representatives voting with the Democrats. The measure has been sent to the Senate.  If it passes the Senate and is signed into law, it will take effect in 2023.

We’ll keep you posted if this bill lands on President Biden’s desk and he signs it.