On January 15, 2022, health insurers will be subject to new federal requirements to cover and waive cost-sharing for over-the-counter diagnostic tests for COVID-19 for the duration of the federal public health emergency. Past federal guidance required insurers to fully cover COVID-19 tests, but allowed them to require enrollees to first obtain a health professional’s determination that a test is medically necessary. The new requirements, published January 10, enable consumers to obtain the tests directly from pharmacies or online retailers without being seen by a health professional. With case rates surging and the costs of over-the-counter COVID-19 tests ranging from $14 to $34, this new benefit should provide significant financial relief to privately insured individuals. This expert perspective focuses on key provisions of the new coverage requirements as well as health equity considerations and implications for state insurance regulators.
Designing Consumer Assistance Programs: Resources from the Field
National Academy for State Health Policy – Katie Baudouin, Christina Miller, and Rachel Dolan
This issue brief, prepared by the National Academy for State Health Policy (NASHP), outlines major state decisions regarding coverage expansion consumer assistance strategies and lists valuable tools that state officials can use when determining how to meet the needs of new and existing consumers. The appendix includes links to resources that can help state officials design consumer assistance programs. The brief covers four major methods states are considering to provide consumer assistance:
– Outreach and engagement through marketing and advertising;
– Enrollment assistance through navigators and in-person assistors;
– Engagement of insurance producers (inclusive of both agents and brokers); and,
– Individualized support through call centers and other communications.
The State Network also released two additional consumer assistance focused briefs. Wakely Consulting Group’s brief, What Should Exchanges Know about Call Centers: A Guide for Implementation,offers states strategies and best practices for Call Center management. Navigators and In-Person Assistors: State Policy and Program Design Considerations, is a brief produced by State Networkstaff that outlines Navigator roles and provides a resource list for state officials.