Millions of Tricare Beneficiaries Left Out of COVID-19 Test Reimbursement Plan

The Biden administration's plan to cover the cost of home COVID-19 tests does not apply to Tricare beneficiaries.

Beginning Saturday, private and group health insurers will be required to reimburse the cost of eight take-home COVID tests per month under an initiative announced by President Joe Biden on Jan. 10.

But as a federal health program, Tricare's nearly 8 million beneficiaries who aren't on active duty will not have the same access, although the military health system is reviewing its policies, according to a Defense Health Agency spokesman.

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Under Tricare, tests are covered only when ordered by a doctor for patients with symptoms; who have had prolonged exposure but no symptoms; are having surgery; or are overseas and need to be tested.

All other reasons -- personal concern, workplace safety, returning to work or school, travel or access to services -- are not covered.

In a major effort to broaden access to testing across the U.S., Biden ordered insurers to cover the cost of eight COVID-19 test kits per month for people with health insurance starting Jan. 15.

The initiative requires insurers to reimburse for the full cost of take-home tests at their network pharmacies and at out-of-network retailers for a $12 copayment per test.

And under the directive, patients with an underlying health condition or other factors will not be limited on the number of tests they can be reimbursed for if they have a doctor's order.

Since the beginning of the COVID-19 pandemic, Tricare beneficiaries have been able to have their COVID-19 tests covered only if they have symptoms or have been in contact with a person who has tested positive and they have a doctor's order.

Tricare spokesman Peter Graves said Thursday that policy remains in place but the Department of Defense is reexamining its rules.

"The Defense Health Agency is reviewing the latest guidance on at-home testing kits in order to identify whether any changes to the current policy are warranted," Graves said in an email to Military.com.

The new insurance reimbursement plan also does not apply to Medicare, which provides the primary coverage for military beneficiaries who use Tricare For Life – meaning those patients are also excluded under the initiative.

Despite not being covered under the federal program's reimbursement plan, Tricare users should still be able to get access to free tests.

As part of the announcement, the government will establish "thousands of locations," according to Biden, to distribute free take-home tests and will create a website for anyone to order free rapid antigen tests for delivery.

Beginning Jan. 19, anyone can order free tests for home delivery at  www.COVIDTests.gov.

Some states like Vermont already have programs in place that require insurers to reimburse for tests. Other states, including Colorado, Connecticut, Iowa, Maryland, Massachusetts, New Hampshire, New Jersey and Washington, as well as the District of Columbia, already have been giving away free tests at COVID-19 test sites, community centers, libraries and community health clinics.

With the spread of the Omicron variant of the illness, test kits have remained in short supply at retailers and via community distribution.

Earlier this month, the Defense Department awarded contracts to a number of rapid antigen test makers, including Abbott, maker of the BinaxNOW test; iHealth Lab; and Roche Diagnostics for the purchase of 380 million over-the-counter tests, and to Goldbelt Security for distribution of a planned 500 million tests.

The DoD is the contracting agency because it has the infrastructure and capability to "acquire goods and services as rapidly and effectively as possible for the federal government in support of the American public," according to Pentagon spokeswoman Jessica Maxwell.

There have been more than 460,000 cases of COVID-19 diagnosed in the military community since the beginning of the pandemic, including military personnel, family members, civilian employees and contractors.

Nearly 650 have died, including 88 troops, 34 dependents, 394 civilians and 133 contractors, according to the DoD.

-- Patricia Kime can be reached at Patricia.Kime@Monster.com. Follow her on Twitter @patriciakime.

Related: More Military Medical Teams Sent to US Hospitals Overwhelmed by Omicron