Please do not collect upfront payment from the member.State variations and regulations may apply during this time. We will reimburse COVID-19 testing in accordance with applicable law, including the CARES Act and UnitedHealthcare reimbursement requirements.We continue to monitor regulatory developments during emergency periods.FDA-authorized tests include tests approved for patient use through pre-market approval or emergency use pathways, and tests that are developed and administered in accordance with FDA specifications or through state regulatory approval.Tests must be FDA-authorized to be covered without cost sharing (copayment, coinsurance or deductible).For individuals enrolled in UnitedHealthcare Community Plans, state variations and regulations may apply during this time.This coverage applies to in-network and out-of-of-network tests for Medicare Advantage, Individual and Family Plans and Individual and Group Market health plans.help in the treatment of the virus for a person.diagnose if the virus is present due to symptoms or potential exposure, or.UnitedHealthcare will cover medically appropriate COVID-19 testing during the national public health emergency period (currently scheduled to end May 11, 2023), at no cost share, when ordered or reviewed by a physician or appropriately licensed health care professional* to either: However, the pharmacy may be able to bill Medicare without the card. Members are encouraged to bring their red, white and blue Medicare card – which is different than the plan ID card – to get the free tests.Participating pharmacies can provide the tests and bill Medicare on the member’s behalf.Tests purchased prior to that date are not eligible for reimbursement.įree COVID-19 tests for Medicare beneficiaries are available at participating pharmacies, including CVS, Costco, Walgreens and Walmart. To qualify for coverage, Medicare members must purchase the OTC tests on or after April 4, 2022. The initiative runs from April 4, 2022, through the end of the national public health emergency period on May 11, 2023.įor members enrolled in a Medicare Advantage plan, the tests covered under this initiative will be covered outside of the existing plan’s coverage, and in addition to any over-the-counter tests that may be covered under the plan as a supplemental benefit. This includes members enrolled in UnitedHealthcare’s Medicare Advantage, Medicare Supplement and Medicare Prescription Drug plans. If a member is experiencing COVID-19 symptoms and cannot find an OTC at-home test for purchase, they should be encouraged to consult their health care professional or local health department.īeginning April 4, 2022, all Medicare beneficiaries with Part B coverage are eligible to get 8 free FDA-authorized or approved over-the-counter (OTC) at-home COVID-19 diagnostic tests every calendar month. Members should check it often for updates. This network is being expanded frequently with additional retailers.Members who have an OptumRX logo on the member ID card can purchase OTC tests at these retailers with no up-front cost and do not need to submit a form for reimbursement. UnitedHealthcare has established a network of preferred retailers.Members do not need a prescription, and UnitedHealthcare will not require a prior authorization, to be reimbursed for the OTC at-home tests.Tests purchased prior to that date are not eligible for reimbursement. Tests must be purchased on or after Jan.The limit of 8 tests per member every calendar month does not apply to Standard PCR tests administered by a doctor and processed by a lab.The list continues to evolve as additional FDA emergency use authorizations occur. The FDA website lists tests that fit these criteria.Members can be reimbursed for up to 8 FDA-authorized or approved OTC at-home diagnostic tests per covered member every calendar month at no cost to the member (no cost-sharing, copay, coinsurance or deductible).It does not apply to Medicare Advantage or Medicaid (Community Plan) members. This directive applies to most commercial plan members – Individual and Family Plans, and Individual and Group Market health plans.Health care professionals should be aware of these key details for this directive: The OTC testing coverage page on UHC.com, our member website, has up-to-date information and instructions. This directive will have primary impact on UnitedHealthcare commercial plan members, as they are responsible for purchasing these tests and following the member reimbursement processes. 10, 2022, by the Departments of Labor, Treasury and Health and Human Services (Tri-Agencies) to support the Biden Administration’s directive on OTC at-home testing. This aligns with the guidance released on Jan. 15, 2022, UnitedHealthcare will cover the cost of FDA-authorized or approved over-the-counter (OTC) at-home COVID-19 diagnostic tests purchased on or after Jan.
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