Does insurance pay for at-home COVID tests? Starting Jan. 15, and here’s how.
Starting Saturday, you can get over-the-counter COVID-19 diagnostic tests covered by your health insurance.
If you’re covered by private health insurance or a group health plan, you can get eight FDA-approved at-home coronavirus tests for free every month, the Biden administration announced Monday.
You can go online or to a pharmacy or store, buy a test and either get it paid for upfront by your health plan, or get reimbursed for the cost by submitting a claim to your plan. This applies whether you purchased your health plan on your own or you get health insurance through your job.
“This is all part of our overall strategy to ramp-up access to easy-to-use, at-home tests at no cost,” said Xavier Becerra, secretary of Health and Human Services, in a statement Monday. “Since we took office, we have more than tripled the number of sites where people can get COVID-19 tests for free, and we’re also purchasing half a billion at-home, rapid tests to send for free to Americans who need them.”
Currently, only COVID tests ordered by a doctor can be covered by insurance.
“Testing is critically important to help reduce the spread of COVID-19, as well as to quickly diagnose COVID-19 so that it can be effectively treated. Today’s action further removes financial barriers and expands access to COVID-19 tests for millions of people,” said CMS Administrator Chiquita Brooks-LaSure in a statement.
Today, my administration announced that health insurers will be required to cover the cost of at-home COVID testing kits starting January 15th.
— President Biden (@POTUS) January 10, 2022
How many COVID tests are covered by insurance?
Each of your family members is eligible for eight tests per month. A family of four, who are all covered under the same insurance plan, could get up to 32 tests covered by their health plan every month. That applies regardless of whether they’re bought all at once or separately throughout the month.
The tally is counted by individual test, rather than by package. Each test packaged in one kit counts as part of the eight tests. For example, if you buy a kit with two tests, you have six free tests remaining. You can get eight individual tests or four two-test packages.
MORE: So you’ve got COVID. Who should you tell?
How to get free COVID tests
Soon, insurers and group health plans will set up a network that will allow you to get the free over-the-counter tests directly through certain pharmacies or retailers. The price of the tests will be covered upfront, so you won’t have to submit a claim and be reimbursed later. If you choose to purchase a test at a different pharmacy or retailer outside of the network, you’ll still be reimbursed for up to $12 per test. Save your receipt to submit to your plan for reimbursement.
You can find from your plan whether your insurer will cover over-the-counter tests directly through a program of preferred pharmacies and retailers.
If your health plan does not provide direct coverage, you can be reimbursed for the cost of your test. If you are charged for your test on or after Jan. 15, keep your receipt and submit a claim to your insurance company for reimbursement. You can find out directly from your plan how to submit reimbursement claims. You won’t need a prescription or a note from your doctor. You’ll be reimbursed for the full cost of the test. For example, if you buy a two-pack of tests for $34, the insurer would reimburse $34.
To get the tests, there are no requirements like deductibles, co-payments or coinsurance, prior authorization, or other medical management requirements.
Will insurance cover at-home COVID tests I already bought?
Any at-home, over-the-counter COVID-19 tests purchased on or after Jan. 15 will be covered. Some plans might also cover tests purchased before Jan. 15. Contact your health plan to ask about getting reimbursed for tests you bought before Jan. 15.
MORE: Where to find at-home tests in Fort Worth
What if you can’t afford to pay for at-home tests upfront?
If your plan requires you to pay upfront and get reimbursed later, you can visit one of the many free testing sites in the Fort Worth area. A list of community-based testing sites can be found here.
Or, you can get the test administered by a health care provider like a nurse, doctor or pharmacist, for free.
How about public health insurance?
Public insurance is not part of the new program.
State Medicaid and Children’s Health Insurance Program programs are required to cover at-home COVID-19 tests without cost-sharing requirements. If you have Medicaid or CHIP coverage, contact the agency for information about coverage for at-home COVID-19 tests.
Medicare pays for COVID-19 diagnostic tests performed by a laboratory, such as PCR and antigen tests. When the test is ordered by a health care professional, there’s no cost-sharing. Medicare Advantage plan members should check with their plan to see if it offers coverage for at-home over-the-counter COVID-19 tests.
COVID tests without insurance?
If you don’t have insurance, you can get free at-home tests from a local community health center. The U.S. Department of Health and Human Services is providing up to 50 million free at-home tests to community health centers and Medicare-certified health clinics.
Starting later this month, the government will distribute 500 million free test kits to Americans.
The DHHS is working on “an accelerated contracting timeline” to get free tests to the public as soon as possible, according to a Dec. 29 White House briefing.
“The first deliveries for manufacturers will start in January. We’ll set up a free and easy system, including a new website to get these tests out to Americans,” White House COVID-19 Response Coordinator Jeff Zients said. “We’re actively working to finalize that distribution mechanism, which includes a website where people will be able to order tests for free. And we’ll share more details in the weeks ahead — days and weeks ahead.”
This story was originally published January 12, 2022 at 7:00 AM.
