Free COVID-19 tests are available. Here’s how you can get yours.
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
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.
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.
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:
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.
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.
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.
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.