5 things you need to know about "FREE" at home Covid-19 tests

Americans keep hearing that it is important to test frequently for covid-19 at home. But just try to find an “at-home” rapid covid test in a store and at a price that makes frequent tests affordable.

Testing, as well as mask-wearing, is an important measure if the country ever hopes to beat covid, restore normal routines and get the economy running efficiently. To get Americans cheaper tests, the federal government now plans to have insurance companies pay for them.

The Biden administration announced Jan. 10 that every person with private insurance can get full coverage for eight rapid tests a month. You can either get one without any out-of-pocket expense from retail pharmacies that are part of an insurance company’s network or buy it at any store and get reimbursed by the insurer.

Congress said private insurers must cover all covid testing and any associated medical services when it passed the Families First Coronavirus Response Act and the Coronavirus Aid, Relief and Economic Security, or CARES, Act. The have-insurance-pay-for-it solution has been used frequently through the pandemic. Insurance companies have been told to pay for PCR tests, covid treatments and the administration of vaccines. (Taxpayers are paying for the cost of the vaccines themselves.) It appears to be an elegant solution for a politician because it looks free and isn’t using taxpayer money.

1. Are the tests really free?

Well, no. As many an economist will tell you, there ain’t no such thing as a free lunch. Someone has to pick up the tab. Initially, the insurance companies bear the cost. Cynthia Cox, a vice president at KFF who studies the Affordable Care Act and private insurers, said the total bill could amount to billions of dollars. Exactly how much depends on “how easy it is to get them, and how many will be reimbursed,” she said.

2. Will the insurance company just swallow those imposed costs?

If companies draw from the time-tested insurance giants’ playbook, they’ll pass along those costs to customers. “This will put upward pressure on premiums,” said Emily Gee, vice president and coordinator for health policy at the Center for American Progress.

Major insurance companies like Cigna, Anthem, UnitedHealthcare and Aetna did not respond to requests to discuss this issue.

3. If that’s the case, why haven’t I been hit with higher premiums already?

Insurance companies had the chance last year to raise premiums but, mostly, they did not.

Why? Perhaps because insurers have so far made so much money during the pandemic they didn’t need to. For example, the industry’s profits in 2020 increased 41% to $31 billion from $22 billion, according to the National Association of Insurance Commissioners. The NAIC said the industry has continued its “tremendous growth trend” that started before covid emerged. Companies will be reporting 2021 results soon.

The reason behind these profits is clear. You were paying premiums based on projections your insurance company made about how much health care consumers would use that year. Because people stayed home, had fewer accidents, postponed surgeries and, often, avoided going to visit the doctor or the hospital, insurers paid out less. They rebated some of their earnings back to customers, but they pocketed a lot more.

As the companies’ actuaries work on predicting 2023 expenditures, premiums could go up if they foresee more claims and expenses. Paying for millions of rapid tests is something they would include in their calculations.

4. Regardless of my premiums, will the tests cost me money directly?

It’s quite possible. If your insurance company doesn’t have an arrangement with a retailer where you can simply pick up your allotted tests, you’ll have to pay for them — at whatever price the store sets. If that’s the case, you’ll need to fill out a form to request a reimbursement from the insurance company. How many times have you lost receipts or just plain neglected to mail in for rebates on something you bought? A lot, right?

Here’s another thing: The reimbursement is set at $12 per test. If you pay $30 for a test — and that is not unheard of — your insurer is only on the hook for $12. You eat the $18.

And by the way, people on Medicare will have to pay for their tests themselves. People who get their health care covered by Medicaid can obtain free test kits at community centers.

A few free tests are supposed to arrive at every American home via the U.S. Postal Service. And the Biden administration has activated a website where Americans can order free tests from a cache of a billion the federal government ordered.

5. Will this help bring down the costs of at-home tests and make them easier to find?

The free covid tests are unlikely to have much immediate impact on general cost and availability. You will still need to search for them. The federal measures likely will stimulate the demand for tests, which in the short term may make them harder to find.

But the demand, and some government guarantees to manufacturers, may induce test makers to make more of them faster. The increased competition and supply theoretically could bring down the price. There is certainly room for prices to decline since the wholesale cost of the test is between $5 and $7, analysts estimate. "It’s a big step in the right direction," Gee said.


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SNAFUs appear in Biden administration home rapid test rollout

Photo: Jan Kopřiva/Pexels

(Kaiser Health News) -- In the past week, the Biden administration launched two programs that aim to get rapid covid tests into the hands of every American. But the design of both efforts disadvantages people who already face the greatest barriers to testing.

From the limit placed on test orders to the languages available on websites, the programs stand to leave out many people who don’t speak English or don’t have internet access, as well as those who live in multifamily households. All these barriers are more common for non-white Americans, who have also been hit hardest by covid. The White House told KHN it will address these problems but did not give specifics.

It launched a federally run website on Jan. 18 where people can order free tests sent directly to their homes. But there is a four-test limit per household. Many homes could quickly exceed their allotments — more than a third of Hispanic Americans plus about a quarter of Asian and Black Americans live in households with at least five residents, according to an analysis of Census Bureau data by KFF. Only 17% of white Americans live in these larger groups.

"There are challenges that they have to work on for sure," said Dr. Georges Benjamin, executive director of the American Public Health Association.

Also, as of Jan. 15, the federal government requires private insurers to reimburse consumers who purchase rapid tests.

When the federal website — with orders fulfilled and shipped through the United States Postal Service — went live this week, the first wave of sign-ups exposed serious issues.

Some people who live in multifamily residences, such as condos, dorms, and houses sectioned off into apartments, reported on social media that if one resident had already ordered tests to their address, the website didn’t allow for a second person to place an order.

"They’re going to have to figure out how to resolve it when you have multiple families living in the same dwelling and each member of the family needs at least one test. I don’t know the answer to that yet," Benjamin said.

USPS spokesperson David Partenheimer said that while this seems to be a problem for only a small share of orders, people who encounter the issue should file a service request or contact the help desk at 1-800-ASK-USPS.

A White House official said 20% of shipments will be directed every day to people who live in vulnerable ZIP codes, as determined by the Centers for Disease Control and Prevention’s social vulnerability index, which identifies communities most in need of resources.

Another potential obstacle: Currently, only those with access to the internet can order the free rapid tests directly to their homes. Although some people can access the website on smartphones, the online-only access could still exclude millions of Americans: 27% of Native American households and 20% of Black households don’t have an internet subscription, according to a KHN analysis of Census Bureau data.

The federal website is currently available only in English, Spanish, and Chinese.

According to the White House, a phone line is also being launched to ease these types of issues. An aide said it is expected to be up and running by Jan. 21. But details are pending about the hours it will operate and whether translators will be available for people who don’t speak English.

However, the website is reaching one group left behind in the initial vaccine rollout: blind and low-vision Americans who use screen-reading technology. Jared Smith, associate director of WebAIM, a nonprofit web accessibility organization, said the federal site "is very accessible. I see only a very few minor nitpicky things I might tweak."

The Biden administration emphasized that people have options beyond the rapid-testing website. There are free federal testing locations, for instance, as well as testing capacity at homeless shelters and other congregate settings.

Many Americans with private health plans could get help with the cost of tests from the Biden administration reimbursement directive. In the days since its unveiling, insurers said they have moved quickly to implement the federal requirements. But the new systems have proved difficult to navigate.

Consumers can obtain rapid tests — up to eight a month are covered — at retail stores and pharmacies. If the store is part of their health plan’s rapid-test network, the test is free. If not, they can buy it and seek reimbursement.

The program does not cover the 61 million beneficiaries who get health care through Medicare, or the estimated 31 million people who are uninsured. Medicaid and the Children’s Health Insurance Program are required to cover at-home rapid tests, but rules for those programs vary by state.

And the steps involved are complicated.

First, consumers must figure out which retailers are partnering with their health plans and then pick up the tests at the pharmacy counter. As of Jan. 19, however, only a few insurance companies had set up that direct-purchase option — and nearly all the major participating pharmacies were sold out of eligible rapid tests.

Instead, Americans are left to track down and buy rapid tests on their own and then send receipts to their insurance providers.

Many of the country’s largest insurance companies provide paper forms that customers must print, fill out, and mail along with a receipt and copy of the box’s product code. Only a few, including UnitedHealthcare and Anthem, have online submission options. Highmark, one of the largest Blue Cross and Blue Shield affiliates, for instance, has 16-step instructions for its online submission process that involves printing out a PDF form, signing it, and scanning and uploading it to its portal.

Nearly 1 in 4 households don’t own a desktop or laptop computer, according to the Census Bureau. Half of U.S. households where no adults speak English don’t have computers.

A KHN reporter checked the websites of several top private insurers and didn’t find information from any of them on alternatives for customers who don’t have computers, don’t speak English, or are unable to access the forms due to disabilities.

UnitedHealthcare and CareFirst spokespeople said that members can call their customer service lines for help with translation or submitting receipts. Several other major insurance companies did not respond to questions.

Once people make it through the submission process, the waiting begins. A month or more after a claim is processed, most insurers send a check in the mail covering the costs.

And that leads to another wrinkle. Not everyone can easily deposit a check. About 1 in 7 Black and 1 in 8 Hispanic households don’t have checking or savings accounts, compared with 1 in 40 white households, according to a federal report. Disabled Americans are also especially likely to be "unbanked." They would have to pay high fees at check-cashing shops to claim their money.

"It’s critically important that we are getting testing out, but there are limitations with this program," said Dr. Utibe Essein, an assistant professor of medicine at the University of Pittsburgh School of Medicine. "These challenges around getting tests to individuals with language barriers or who are homeless are sadly the same drivers of disparities that we see with other health conditions."

KHN Midwest correspondent Lauren Weber contributed to this report.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Latest diet guidelines features new guidance for infants and toddlers

In the United States, more than half of all adults have in our country suffer from one or more chronic diseases that would be preventable proper eating habits and regular exercise. Every five years since 1980, the U.S. Department of Health and Human Services (HHS) and U.S. Department of Agriculture (USDA) has published the Dietary Guideline for Americans to help citizens adopt and maintain a healthier diet and lifestyle.

Primarily intended for policymakers, nutrition educators and healthcare providers, the report outlines steps to help people improve their overall eating habits.

In the latest report, there are now new national guidelines designed for the unique nutrition needs of pregnant women, lactating moms, infants and toddlers.

One of the key takeaway in the report is how important eggs are as a first food for infants and toddlers, as well as for pregnant women and lactating moms. As a vital source of nutrients for people of all ages, eggs provide several key nutrients important for babies during the time in which their brains are most rapidly developing.

Choline, a nutrient found in large quantities in eggs and now a recommended first food for babies to reduce risk for an egg allergy, has now been recognized as important for brain health.

"Understanding the importance of nutrition in the first years of life builds a foundation for lifelong health and prevent chronic disease."
According to the American Egg Board, just one large egg provides the daily choline needs for babies and toddlers, and two large eggs provide more than half of daily choline needs for pregnant moms.

The report notes that between 4-6 months of age and when a baby is developmentally ready introducing "potentially allergenic foods" like eggs, peanuts, shellfish and soy products with other complementary foods is a good idea. Authors say there is "no evidence that delaying" adding allergenic foods to an infant's diet will prevent the development of a food allergy. In fact, it may also help reduce the risk of one.

"The new Dietary Guidelines for Americans confirm what the science has shown: eggs provide critical nutritional support for brain health, and they play a crucial role in infant development and prenatal health," said Emily Metz, president and CEO of the American Egg Board. The AEB is the U.S. egg industry's national commodity marketing board whose mission is to increase demand for eggs and egg products through research, education and promotion. "With 90% of brain growth happening before kindergarten, eggs help make every bite count, especially when babies are just being introduced to solid foods."

Gerber Products Company, a leading company in infant nutrition founded in 1928, says understanding the importance of nutrition in the first years of life builds a foundation for lifelong health and prevent chronic disease.

"These new Dietary Guidelines are a tremendous step in the right direction to set up moms and babies for long-term success in their health," said Dr. Erin Quann, Registered Dietitian, head of Medical Affairs at Gerber/Nestlé Nutrition. "At Gerber, research such as our Feeding Infants and Toddlers Study (FITS) informs everything we do – from the products we make, the nutrition education we deliver and the services we offer. We are thrilled to see this science-based approach to baby's nutrition take a more prominent place within the Dietary Guidelines for Americans."

One of the recommendations is for approximately the first 6 months of life, infants should feed exclusively on breast milk and continue to feed on mother's milk through at least the first year or longer, if desired. When human milk is not available an iron-fortified infant formula is the next best thing.

The diets of infants and toddlers should avoid foods with little nutritional value and large amounts of added sugar. Sugar-sweetened beverages like fruity drinks for babies and toddlers should be avoided.

The report also points out that during the second year of life children continue to have high nutrient needs from small amounts of foods. Toddlers should consume a variety of nutrient-dense fruits, vegetables, whole grains and dairy products like cheese, milk and yogurt. High protein foods, including lean meats, poultry, eggs, seafood, nuts, and seeds are also recommend to promote healthy early development.

"From Gerber infant cereals fortified with iron, to nutritious meal and snack options with fruits, veggies and whole grains, and even beverages made without added sweeteners, Gerber has long been developing products that make every bite count," said Sarah Smith-Simpson, principal scientist at Gerber. "The release of these new Dietary Guidelines reinforces our mission to establish healthy eating habits right from the start. Gerber will continue our work to advance research and high-quality products that further support baby's dietary needs."


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