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As part of its overall strategy to ramp up COVID-19 testing, the United States President Joe Biden’s administration is now requiring all private insurance companies, both individual and group, to cover the costs of at-home COVID-19 tests purchased on or after January 15, 2022.

In addition to the free test kits offered through covidtest.gov, the requirement opens up widespread testing to millions of Americans. There are different ways in which insurance companies implement the requirement, although they are heavily incentivized to create “direct pay” networks that do not require any upfront payment from members.

What You Should Know About Free COVID-19 Tests From Your Insurance Company

  • Up to eight tests: All private insurance companies must cover up to eight home test kits per person per month.
  • Order online or get reimbursed: Many major insurers either have or are working on a direct shipping option for free COVID-19 tests. Or, you can get reimbursement by submitting a claim form.
  • Medicaid covers tests: Medicaid recipients can get free COVID-19 tests. Medicare does not cover tests, but Medicare Advantage Plans may offer coverage.

How Do You Get Free At-Home COVID-19 Tests?

Americans may access no-cost tests in several ways. Currently, every household in the U.S. can go to covidtest.gov and order up to four free at-home tests that will ship in seven to-12 days. Also, individuals covered by a health plan may purchase up to eight FDA-approved test kits per month over the counter and have those costs covered by their insurance. However, the coverage mechanism will vary by insurer.

Does Insurance Cover COVID-19 Tests?

All private health insurance must cover the costs of up to eight home test kits per person, per month, although the actual process varies by insurer. That means that a family of four is entitled to up to 32 tests per month at no cost. Some insurers have set up, or are in the process of setting up, networks of preferred pharmacies and retailers at which members can purchase test kits with a “direct pay” mechanism. That means that the member doesn’t have to pay anything out of pocket or navigate a difficult reimbursement process as long as the kit is purchased through a preferred retailer.

Some insurers may also offer kits that can be ordered online. Other insurance companies require the member to purchase the kits and pay for them upfront, then submit the cost for reimbursement through the plan. Members with plans that offer direct coverage may still purchase kits at nonpreferred retailers, but the reimbursement for those is capped at $12.

How Do You Get Reimbursed for COVID-19 Tests by Your Insurance?

Here are some helpful links and information for 13 major private insurers that have at least 1 million fully insured members across their U.S. subsidiaries. According to kff.org, these private insurers cover about six of 10 people in the fully insured commercial market:

  • Aetna/CVS Group (reimbursement): Aetna is in the process of developing a direct-to-consumer shipping option but, for now, reimbursement by claim form is the current option. For more details, click here.
  • Anthem (online reimbursement): Anthem has online order options for at-home test kits but supplies are limited. Claims for reimbursement may be submitted online with a receipt. For more information, click here.
  • Blue Shield of California (reimbursement): Members only have the option to submit claim formsby mail with a receipt and the UPC bar code from the test. For more details, click here.
  • Blue Shield of Michigan (reimbursement): Submit claim forms with a receipt by mail. For more information, click here.
  • Blue Shield of North Carolina (both):Members may use their member ID card at an in-network retailer and pay no out-of-pocket cost or submit a claim formwith a receipt and UPC bar code from the test for reimbursement by mail. Members are eligible for no more than $12 per individual test kit with a maximum of up to eight over-the-counter (OTC) at-home kits per month. For more information, click here.
  • Care First (reimbursement):Claim form submission is by mail. Members must include their receipt and UPC bar code for the test to receive the reimbursement. For more information, click here.
  • Centene/Ambetter (both): In-network retailersare available to get OTC at-home COVID-19 tests. The member ID card must be presented to receive the kit at no out-of-pocket cost. Paperclaim formsmay also be mailed with a receipt for reimbursement when paying out-of-pocket.
  • Cigna (reimbursement): Submit claim formswith a receipt by mail or fax. Members are eligible for up to eight individual at-home COVID-19 test kits per month. For more information, click here.
  • Guidewell/Florida Blue (both): Members may use their member ID card at anin -network pharmacy and pay no out-of-pocket cost or submit a claim formwith a receipt for reimbursement by mail. Members are eligible for no more than $12 per individual test kit. For more details, click here.
  • Healthcare Service Corp (both): Submitclaim forms with a receipt by mail or present member ID cards at in-network pharmacies and pay no out-of-pocket cost. Members are eligible for no more than $12 reimbursement per individual test kit.
  • Humana (both): Members may use their member ID card at an in-network pharmacy and pay no out-of-pocket cost or submit a claim formwith a receipt for reimbursement by mail. Members are eligible for reimbursement maximum of up to eight OTC at-home kits per month. For more information,click here.
  • Kaiser Permanente (reimbursement): Claim for reimbursement may be submitted online go to “Coverage & Costs” on kp.org and select “Submit a medical claim.”Receipt and Universal Product Code (UPC) or quick response (QR) bar code must be submitted with the claim.For further information, click here.
  • United Healthcare (direct pay): Members that have an OptumRX logo on their card may go directly to a preferred retail provider and receive an OTC at-home COVID-19 test at no out-of-pocket cost. If a member chooses to use an out-of-network retailer, then they must submit a claim reimbursement form by mail or online. Reimbursement does cap at $12 for individual tests. For more details, click here.

Can you get reimbursed for the COVID-19 tests you already purchased?

Health plans are required to cover the costs of kits purchased on or after January 15, 2022. Insurers may provide such coverage for kits purchased before January 15, 2022, but they are not required to. Additionally, some states may have their own requirements. If you have purchased kits before January 15, 2022, contact your insurance company to find out about getting reimbursed for those tests.

Does Medicaid Cover COVID-19 Tests?

State Medicaid and Children’s Health Insurance Plans (CHIP) are required to cover U.S. Food and Drug Administration (FDA)-approved test kits with no cost-sharing. That means that recipients do not have to pay anything out of pocket and go through a reimbursement process, because many would lack the resources to do so. However, states do have discretion in how to implement these rules, and some may require a prescription as a prerequisite.

Does Medicare Cover COVID-19 Tests?

Medicare Part B covers 100% of the costs for tests administered at a pharmacy, doctor’s office, laboratory, or hospital when it has been ordered by a doctor. Original Medicare does not currently cover at-home test kits. Provisions in the Families First Coronavirus Response Act eliminate cost-sharing for Medicare and Medicare Advantage enrollees when related to COVID-19 testing and testing-related services. Prior Authorization and utilization management requirements for these services are prohibited.

Medicare Advantage plans are not required to cover over-the-counter tests, although some may with a physician’s order. If you are in a Medicare Advantage plan, contact the plan to see if it will cover these tests. For those whose plan does not, they may still order up to four free kits per household at covidtest.gov. Additionally, many community-based testing sites and Medicare-certified clinics offer free at-home tests or on-site testing.

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Tammy Burns
Insurance and health care consultant

Tammy Burns is an experienced health insurance advisor. She earned her nursing degree in 1990 from Jacksonville State University, obtained her insurance billing and coding certification in 1995, and holds a health and life insurance license in Alabama, Georgia, Iowa, Mississippi, and Tennessee. Burns is Affordable Care Act (ACA)-certified for health insurance and other ancillary, life, and annuity products. She maintains an active nursing license and practices private-duty nursing.

Burns’ background as a nurse, insurance biller and coder, and insurance consultant includes infectious disease, oncology, gynecology, phlebotomy, post operative, family medicine, geriatrics, home health, hospice, human resources, management, billing, coding, claims, fixed annuities, group and individual health and life products, and Medicare. She’s always been driven by a desire to help people, spending more than 25 years as a practicing nurse in hospitals, private doctors’ offices, home health, and hospice. As a nurse, Burns supported patients filing insurance claims with Medicare, Medicaid, and private insurance companies as well as responding to billing questions from confused patients.

Seeing firsthand how unsuspecting patients are frequently confused by an overly complex system they don’t understand led Burns to become an insurance agent and health care consultant, now helping people understand the medical system. Since becoming an insurance agent in 2013, she has worked with some of the largest and most reputable insurance carriers and agencies in the nation, and she has built a large and loyal clientele by way of her commitment to transparency and personalized service.

author-img
Tammy Burns
Insurance and health care consultant

Tammy Burns is an experienced health insurance advisor. She earned her nursing degree in 1990 from Jacksonville State University, obtained her insurance billing and coding certification in 1995, and holds a health and life insurance license in Alabama, Georgia, Iowa, Mississippi, and Tennessee. Burns is Affordable Care Act (ACA)-certified for health insurance and other ancillary, life, and annuity products. She maintains an active nursing license and practices private-duty nursing.

Burns’ background as a nurse, insurance biller and coder, and insurance consultant includes infectious disease, oncology, gynecology, phlebotomy, post operative, family medicine, geriatrics, home health, hospice, human resources, management, billing, coding, claims, fixed annuities, group and individual health and life products, and Medicare. She’s always been driven by a desire to help people, spending more than 25 years as a practicing nurse in hospitals, private doctors’ offices, home health, and hospice. As a nurse, Burns supported patients filing insurance claims with Medicare, Medicaid, and private insurance companies as well as responding to billing questions from confused patients.

Seeing firsthand how unsuspecting patients are frequently confused by an overly complex system they don’t understand led Burns to become an insurance agent and health care consultant, now helping people understand the medical system. Since becoming an insurance agent in 2013, she has worked with some of the largest and most reputable insurance carriers and agencies in the nation, and she has built a large and loyal clientele by way of her commitment to transparency and personalized service.

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