(Credit: Ross Todd/ALM)
Private health plans no longer will be required to provide COVID-19 tests without cost to consumers when the public health emergency ends on Thursday. Although the vast majority of people with private health insurance will continue to have coverage for tests ordered or administered by a clinician, these tests soon will be subject to cost sharing, quantity limits and prior authorization requirements.
Some health plans may voluntarily continue to cover at-home tests but won't be required by federal law to do so. Therefore, people with health insurance may face the full cost of tests if they are within their deductible, subject to quantity limits or denied coverage through prior authorization, or if they purchase an at-home test that is not covered through their insurance. People without health insurance will face the full cost of COVID-19 tests if performed in the typical clinical setting.
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Prices for testing varied widely in a new study reported in the Peterson-KFF Health System Tracker.
"We find that the median price of a COVID-19 test in an outpatient clinical setting was $45 in 2021 among people with large employer-based health coverage, though prices varied widely," researchers say. "Among hospitals disclosing price transparency data, the median discounted hospital-based self-pay rate was $51 for a COVID-19 antigen test and $91 for a PCR test. We find that recent prices for at-home rapid COVID-19 tests average about $11 per test."
In other findings:
- In outpatient clinical settings, test prices varied significantly. Factors that affect the price include the test type (antigen vs. PCR) as well as whether additional respiratory pathogens were included as part of a test panel. However, prices also varied within various types of diagnostic tests. Generally, antigen testing was less expensive than PCR testing, with a median price of $42 compared to $62 for PCR testing.
- In hospital price transparency data, median self-pay rates for COVID-19 PCR tests vary widely by state. PCR testing was the most expensive in Alaska, with a median self-pay rate of $200, and least expensive in Utah, with a median self-pay rate of $41.
- At-home COVID-19 tests typically cost about $11 per test. Most at-home rapid tests cost between $12 and $24 per two-pack. The total cost for a pack of tests ranged from $8 for a one-test pack to $40 for a four-test pack.
Read more: So, how much are 'free' COVID tests actually costing the government?
"Moving ahead, enrollee cost sharing for COVID-19 tests in a clinical setting will depend on their health plan and where they receive a test," researchers conclude. "In instances where the health plan applies a deductible or if the test is performed out-of-network, the enrollee could face the full costs."
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Alan Goforth
Alan Goforth is a freelance writer in suburban Kansas City. In addition to freelancing for several publications, he has written a dozen books about sports and other topics.
