Using Your Health Insurance
As of January 15, 2022, a new federal policy under the Families First Coronavirus Response Act (FFCA) requires health insurers to cover up to eight over-the-counter (OTC) COVID-19 tests per month with no clinical assessment or up-front cost for each covered member, if the tests are purchased on or after that date.
Consumers should check with their health insurer about direct coverage options through a preferred pharmacy or direct-to-consumer shipping program.
Health insurers that arrange for pharmacies and other retailers to cover the up-front costs of these tests will only be required to reimburse up to $12 per test (or the full cost of the test, whichever is lower) if the test is purchased through an out-of-network provider. In these cases, a consumer may need to provide a copy of the receipt. If tests are temporarily unavailable through direct coverage options due to a supply shortage, and insurer may continue to limit reimbursement to $12 per test (or the full cost of the test, whichever is lower) for OTC COVID-19 tests purchased outside of the direct coverage program.
A health insurer may limit coverage of OTC COVID-19 tests purchased without the involvement of a health care provider to tests purchased from established retailers typically expected to sell OTC COVID-19 tests. Tests purchased from a private individual, online person-to-person, or an online resale or auction marketplace may not be covered. The only OTC COVID-19 tests that must be covered are tests authorized for use by the Food and Drug Administration (FDA) that can be obtained without a prescription, used and processed without a laboratory, and purchased.
It is important to note that a flex spending account (FSA) or health savings account (HSA) may not provide reimbursement for an OTC COVID-19 test that was paid or reimbursed by an insurer.
Insurers are permitted to take reasonable steps to prevent, detect, and address fraud and abuse.
For more information, please go to https://www.cms.gov/how-to-get-your-at-home-OTC-COVID-19-test-for-free.
Free From the Federal Government
For Everyone:
You can also order four free rapid antigen at-home tests per household directly from the federal government. Test kits will be shipped through the US Postal Service starting in late January.
No insurance is required to get these tests.
You can sign up to get yours at https://www.covidtests.gov/.
For Medicare Beneficiaries:
Beginning April 4, 2022, and until the end of the public health emergency, Medicare will cover over-the-counter self-administered COVID-19 tests at no cost to beneficiaries if you have Medicare Part B, including those enrolled in a Medicare Advantage plan. This is in addition to the eight free at-home tests you can continue to order per month from the federal government at https://www.covidtests.gov/. You can get OTC COVID-19 tests at any pharmacy or health care provider that participates in this initiative. Check with your pharmacy or health care provider to see if they are participating. You can find list of eligible pharmacies and other health care providers at https://www.medicare.gov/medicare-coronavirus#300.
Because additional eligible pharmacies and health care providers may also participate, people with Medicare should check with their pharmacy or health care provider to find out whether they are participating.
Please note that Medicare won’t cover OTC COVID-19 tests if you only have Medicare Part A (Hospital Insurance) coverage, but you may be able to get free tests through other programs.
Additional information may be found at https://www.medicare.gov/medicare-coronavirus#300 and https://www.cms.gov/newsroom/fact-sheets/medicare-covers-over-counter-covid-19-tests.
