Consumers Face Struggles with COVID-19 Testing Access, Coverage

More than 20 percent of consumers have experienced barriers to COVID-19 testing in the last six months, such as struggling to find a test or forgoing a test because there were no testing options available, according to eHealth’s Consumer Sentiment on COVID Care, Policy, and More survey.

As the Omicron variant continues to spread across the country, COVID-19 tests have been in high demand.

CMS and the Biden Administration recently announced that commercial health insurers are required to cover the costs of at-home COVID-19 tests, either upfront at the counter or by reimbursing consumers after the purchase.

However, consumers are facing barriers when it comes to accessing tests in the first place.

eHealth has been surveying consumers since March 2020 to understand their concerns about the coronavirus pandemic and their perceptions of how the government and healthcare stakeholders are responding.

The most recent survey was conducted in January 2022 and includes responses from 1,077 participants.

Nearly 30 percent of consumers reported that they had experienced difficulty accessing a COVID-19 test in the past six months. The share grew to 47 percent among consumers who have had COVID-19.

Access to testing varied by state as well, with more Midwestern and Northeastern residents facing barriers than Western and Southern residents. For example, 45 percent of respondents from New York and 43 percent from Illinois reported that they had a difficult time accessing a test, whereas only 15 percent of Oregon respondents and 12 percent of respondents from Georgia had difficulties.

One in four consumers reported that they skipped getting a COVID-19 test due to a lack of testing options in their area.

Additionally, 15 percent of consumers have struggled to receive coverage or reimbursement for their COVID-19 tests, despite the CMS policy.

The eHealth consumer sentiment survey results aligned with other studies that have identified consumers’ challenges related to coronavirus testing. 

During the week before CMS announced the coverage requirements, there was a low supply of at-home COVID-19 tests, a Kaiser Family Foundation (KFF) study revealed.

The study looked at six online retailers and ten types of tests, which amounted to 480 possible opportunities for consumers to purchase a test. However, there were only 43 testing opportunities available during that time. The lack of opportunities could have been attributed to retailers being out of stock of the tests or not carrying certain brands.

Reimbursement and coverage issues that consumers faced may be tied to the shortage of tests, as the availability challenges could limit the reach of the CMS policy, according to KFF researchers.

Furthermore, payers are also divided on how they are covering the tests, as CMS offered two possible options.

CMS has extended incentives for payers that take the first route—upfront coverage. Through this method, members can buy a test at the pharmacy or online at no cost. Payers like Blue Cross Blue Shield of North Carolina, Humana, and United Health Group’s commercial plans are offering direct coverage of tests for members.

Other payers, including Blue Shield of California, Blue Cross Blue Shield of Michigan, and Cigna, are offering members reimbursement for tests after they purchase them. These payers may require members to mail their receipts back to their insurance companies to be reimbursed.

The eHealth survey also revealed that, despite health plans’ efforts to be a COVID-19 resource, consumers are mainly getting their information from television, radio, and internet news sites.

More than half of consumers stated that authorities should be prioritizing COVID-19 vaccines as opposed to treatments, which is where payers could be a helpful resource. By engaging members, providers, and community partners, payers may help boost vaccination rates in their member populations, according to the Association for Community Affiliated Plans.