Are COVID Tests Covered by Health Insurance?

If you’re anything like the average American, you’ve likely been tested for COVID at least once. Depending on your employer’s requirements, you may even need to get tested one or more times per week.

Getting tested for COVID can be unpleasant. Many people note that the sensation of having one’s nasal passage swabbed is disagreeable—and the high costs of the tests are perhaps even more painful. If you need to get tested regularly, it can quickly become uneconomical.

Thankfully, there is good news. Beginning January 15, 2022, the Biden-Harris Administration is requiring insurance companies and group health plans to cover the cost of eight over-the-counter, at-home COVID-19 tests per covered individual per month.

This new initiative has been placed in response to the recent Omicron variant surge. It could mean significant financial savings for the insured. A family of four on the same insurance plan, for instance, would be able to get up to 32 tests covered per month.

Details on COVID Testing Coverage

Certain requirements must be met for an over-the-counter, at-home COVID-19 test to be covered by your insurance.

• The test must be authorized, cleared, or approved by the U.S. Food and Drug Administration (FDA).
• It’s possible that your test may be covered upfront only if you purchase it at your insurance provider’s preferred pharmacy.
• If you purchase a test somewhere other than your insurance provider’s preferred pharmacy (such as through an online retailer), your insurance is required to reimburse you up to $12 per individual test. Save your receipts to submit these claims to your insurance.
• If your healthcare provider orders the test for you following an individualized clinical assessment, there is no limit on the number of COVID-19 tests—at-home or otherwise—that can be covered by your insurance.

Can I Get My Past COVID-19 Tests Covered?

According to federal law, insurance plans may—but are not required to—provide coverage for over-the-counter COVID-19 tests purchased before January 15, 2022. Contact your insurance provider with inquiries.

What If I Need More than 8 Tests Per Month?

If you need to test yourself frequently per your employer’s request, insurance plans are not required to provide coverage for over-the-counter COVID-19 tests taken for employment purposes.

If you have any other questions pertaining to your coverage and COVID-19 tests, it’s a good idea to check your insurance plan online for updates or contact your provider.

Coverage Disputes and Claim Denials

If you feel you have grounds to dispute a lapse in insurance coverage, it would be wise to contact an attorney experienced in handling insurance coverage disputes and claim denials as soon as possible.

What If I Have Medicare, Medicaid, or CHIP (Children’s Health Insurance Program)?

The following information is in the Biden Administration’s recently published statement regarding coverage of COVID-19 tests.

• Medicare: Medicare pays for COVID-19 diagnostic tests performed by a laboratory, such as PCR or antigen tests. If you’re enrolled in a Medicare Advantage plan, you should check your plan or contact your provider to find out if at-home, over-the-counter COVID-19 tests can be covered.
• Medicaid: In accordance with the American Rescue Plan, Medicaid programs are currently required to cover at-home, over-the-counter COVID-19 tests.
• CHIP: In accordance with the American Rescue Plan, CHIP programs are currently required to cover at-home, over-the-counter COVID-19 tests.

What If I Don’t Have Insurance?

The Biden Administration endeavors to purchase 500 million at-home, rapid tests to send for free to Americans who need them. This delivery of these tests is slated to begin in January 2022. They will be distributed to community health centers and Medicare-certified health clinics at no costs to patients and community members.

A website will soon be available where you can request these at-home tests to be delivered to you at no cost.

You can find community health centers near you here.

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