As of January 15th, insurance companies must now cover cost of at-home COVID-19 tests. This means most people with private insurance can purchase an at-home COVID-19 test either online or in store and have it paid upfront or can be reimbursed by submitting a claim to their health plan. The process is a little confusing, but here’s what we know:
What kind of COVID-19 tests are covered under this federal government program?
Under the federal government program, at-home, over-the-counter COVID-19 tests that are authorized by the FDA are covered. You can search to see what is FDA authorized here.
How many COVID-19 tests are covered?
Under the new federal requirement, insurance plans must cover eight tests per insured individual per month, regardless of whether the tests are purchased all at once or at different points throughout the month.
Only tests that you purchase yourself count towards the limit of eight per person per month. Tests ordered or administered by a health care professional during or after a clinical assessment do not.
How does my insurance provider cover the costs?
You can get your test free from an in-network store at a pharmacy or through reimbursement from your insurance provider. In general you should:
- Make sure the pharmacy or store you purchase from is in-network to initially receive the test at no cost
- Generally have your insurance card or member ID with you. Every insurance company is different but it’s a good idea to bring it with you especially if you’re purchasing your COVID-19 test at a pharmacy or store.
- Keep the receipt if you purchase a test from a pharmacy that isn’t in-network with your insurance. You can still be eligible to submit a claim for reimbursement.
What does reimbursement process look like?
The reimbursement process can seem a little complex. If your insurance provider has an established network of preferred pharmacies, you may receive a reimbursement of up to $12 per test purchased. However, if your insurance provider has not set up an established network of preferred pharmacies, you may be eligible for reimbursement of the full costs of your tests. It is recommended to check in with your insurance provider to see if they have an established network of preferred pharmacies to understand reimbursement policies better..
Few additional tips:
Here are a few things that will help you get your COVID-19 test covered by your insurance provider:
- Keep all receipts from your test purchases. You will need to submit the receipts with your claim.
- Check directly with your insurance provider about specific rules and to determine which tests are covered.
- Stay up-to-date on new requirements and health information.