Does Health Insurance Cover At-Home COVID Tests? – Verywell Health
In an effort to make at-home rapid tests for COVID-19 more accessible, the Biden administration announced in December 2021 that they would be issuing guidance directing health insurance plans to cover the cost of the tests. That guidance was issued in January 2022, and takes effect January 15, 2022.
This article will describe what you can expect under the new guidance, what health plans are subject to the new rules, and the types of at-home COVID tests that are available.
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Does Health Insurance Cover At-Home COVID Test Kits?
In general, most types of health insurance do cover at-home COVID test kits as of January 15, 2022. The new rules require health plans to cover up to eight tests per month for each person enrolled in the plan, without a need for a prescription or doctor’s order, and regardless of whether the person is symptomatic.
Due to legislation enacted early in the pandemic, most U.S. health insurance plans were already required to cover the cost of COVID testing for a person who was symptomatic or who had been exposed to someone who had tested positive for COVID, and at-home tests were covered in those circumstances if they were prescribed by a doctor.
Prior to January 15, 2022, the coverage requirement did include at-home COVID testing, but only if the at-home COVID test was “ordered by an attending healthcare provider who has determined that the test is medically appropriate for the individual.” Fortunately for people who want to routinely test themselves and their family members, that restriction is no longer in place as of January 15, 2022.
The new guidelines ensure that health plans will cover the cost of COVID tests regardless of any other factors; a person does not have to be symptomatic or under a doctor’s care, and can simply obtain the tests over-the-counter at a pharmacy (as described in more detail below, Medicare still follows the previous rules, even after January 15, 2022).
This requirement is applicable until the end of the COVID public health emergency period. The emergency period has been extended several times and is currently scheduled to continue through mid-January 2022, but is likely to be extended again amid the Omicron surge.
What Should Consumers Expect Under the New Regulations?
As of January 15, 2022, people with employer-sponsored or self-purchased health plans (including grandmothered and grandfathered plans) can obtain at-home COVID tests for free. The Biden administration is encouraging and incentivizing insurers to establish arrangements with local pharmacies that allow people to pick up the tests without having to pay anything at all. But there’s also an option for people to pay out-of-pocket for the cost of the test and then submit the receipt to their insurer for reimbursement.
If the health plan has a network of pharmacies where you can pick up tests for free and you decide to buy a test elsewhere, you can still submit your receipt to your health plan for reimbursement. But the plan is only required to reimburse up to $12 per test in that case (or the full cost of the test, if it’s less than $12). Note that $12 is per test, so if you buy a box that contains two tests, as is commonly the case, your insurer would reimburse up to $24 for the box.
Insurers and health plans have the option to reimburse enrollees for tests purchased prior to January 15, 2022, but are not required to do so.
Although the Biden administration did indicate in early December 2021 that insurers would be required to cover the cost of at-home COVID tests, the official guidance was published just five days before its effective date. So there was still some uncertainty about how readily available the tests would be by mid-January, and how seamless the health insurance coverage would be.
The Blue Cross Blue Shield Association issued a press release soon after the official guidance was published, noting that: “We appreciate the administration’s efforts to address this challenge, including measures to protect against price gouging and abuse. That being said, we are concerned that the policy does not solve for the limited supply of tests in the country and could cause additional consumer friction as insurers stand up a program in just four days’ time. We will continue to partner with the administration and retailers to help make this work and advocate for policies that promote affordable and equitable access.”
So although health plans are covering the cost of at-home COVID tests as of mid-January 2022, consumers should expect that the process will become smoother over time. The availability of tests on store shelves is also expected to improve over time.
Do All Health Plans Cover the Cost of At-Home COVID Tests?
Most health plans in the U.S. are subject to the new regulations that require them to cover the cost of at-home COVID tests. This includes employer-sponsored health plans as well as individual/family health plans that people purchase themselves (including grandmothered and grandfathered plans). Medicaid and CHIP plans are also required to comply with the new regulations.
However, Original Medicare is not included in the new regulations, and does not cover the cost of at-home COVID tests. Some Medicare Advantage plans might choose to make this benefit available to their members, but they are not required to do so.
Health plans that aren’t considered health insurance, such as health care sharing ministry plans, are not subject to the new regulations and do not have to cover the cost of at-home COVID tests. Neither do short-term health insurance or excepted benefits such as fixed indemnity plans.
How Much Do At-Home COVID Test Kits Cost?
The price of at-home COVID test kits depends on whether it’s a rapid at-home antigen COVID test (with results in minutes) or a test kit that you use to collect saliva or a nasal sample at home and then mail to a lab for analysis. If you’re mailing in a sample, it will be a polymerase chain reaction (PCR) test, also known as a molecular test.
There are pros and cons to both approaches. PCR tests are more sensitive and less likely to give you a false negative result (in which you do have a COVID-19 infection but the test shows negative), although the timing of the test is important. Rapid antigen tests give you results in minutes, without having to wait for a lab to process the sample.
Most of the rapid test kits contain two tests, designed to be taken by the same person within a specified amount of time. But there are some single-test kits on the market, and the government is working to streamline the regulatory process to make these single tests more accessible.
For now, single tests can be purchased for as little as $10, and two-pack test kits start at about $14, although the same kits can be more expensive depending on the store. As noted above, the new guidance requires health plans to reimburse members up to $12 per test (up to $24 for a two-pack), which should cover the cost of most rapid antigen tests. And again, health plans are incentivized to establish arrangements with pharmacies to allow members to simply show their insurance card and be able to obtain tests for free, without having to go through the reimbursement process.
Numerous rapid antigen tests have been granted emergency use authorization by the Food and Drug Administration (FDA), and many of them can be used for at-home screening.
If you’re purchasing an at-home PCR test—the kind that involves mailing your saliva sample to a lab for analysis—the price can be upwards of $100.
Should You Use FSA or HSA Funds to Buy At-Home COVID Tests?
If you have a medical flexible spending account (FSA) or a health savings account (HSA), you can use the money in the account to purchase at-home COVID tests. This means you’ll be using pretax money to buy the test kits, and this option has been available ever since at-home COVID tests came on the market.
However, you should not use HSA or FSA funds to buy at-home COVID tests as of January 15, 2022, assuming you’re enrolled in a health plan that will cover the cost of at-home COVID tests. FSA and HSA funds can only be used to pay for medical expenses that are not reimbursed by your health plan. So if you use FSA or HSA funds to buy the test kit, you would not be able to also submit the receipt for reimbursement by your health plan.
HSA funds do not expire, so it’s possible that you might still have money in an HSA even if you no longer have HSA-compliant health insurance. For example, you may have transitioned to Medicare, or opted for something like a health care sharing ministry plan, neither of which are subject to the coverage mandate for at-home COVID tests. In that case, you can use your HSA funds to purchase at-home COVID tests if you choose to do so.
Free At-Home COVID Test Kits Offered By States and Cities
Depending on where you live, you might have access to free COVID test kits that can be picked up locally or delivered to your house. These programs are separate from the health insurance reimbursement program, and may be discontinued as free COVID tests become more widely available via most Americans’ health insurance plans.
Some states and municipalities offer free rapid (antigen) COVID tests for at-home use, while some others offer free PCR (molecular) COVID tests.
With a PCR kit, you’ll collect your own sample—typically while on a video call with a healthcare professional who will make sure you’re doing it correctly. Then, using a pre-addressed envelope that comes with the test kit, you send it to a lab to be analyzed. You’ll get your results after the lab processes your sample.
The following states and municipalities allow residents to receive free at-home COVID test kits. Note that some of these areas have tests available while supplies last, whereas others have partnered with testing agencies that can provide ongoing services.
States and Municipalities Offering Free Rapid At-Home COVID Tests
If free at-home antigen (rapid) tests are available in your area, you can obtain a test, collect your sample, and see within minutes whether the result is negative or positive. Note that these tests typically come in a two-pack, directing you to retest within a specified window of time.
If you get a positive result, or if you’re symptomatic and the at-home test shows a negative result, you may still want to follow up with your healthcare provider to schedule a PCR test. The government is working to make testing more readily available in these situations, too.
Free rapid at-home COVID test kits are available in the following areas:
States and Municipalities Offering Free At-Home PCR COVID Tests
If the free at-home COVID test available in your area is a PCR test, you’ll need to collect your sample, send it to a lab for analysis, and wait to hear back from them to know whether it’s negative or positive. The instructions will be included with your test, and you’ll likely collect the saliva or nasal sample while on a video call with a medical professional.
Free at-home PCR COVID tests are available in the following locations:
Summary
Free in-person COVID testing is readily available in most areas of the country. But if you prefer to take a test in your own home, there are COVID tests available for in-home use.
As of January 15, 2022, most health insurance plans in the U.S. cover the cost of rapid at-home COVID tests. Up to eight at-home COVID tests must be covered for each plan member, and this regulation remains in effect for the duration of the COVID public health emergency period.
Insurers can establish agreements with pharmacies so that members can pick up tests without having to pay anything, or the health plan can reimburse members for the cost of a test.
A Word From Verywell
In living with the COVID pandemic since early 2020, vaccines, masks, and social distancing have become part of our everyday routine. In-person COVID testing has been readily available in most areas for some time, and at-home test kits have been available online and in stores for several months.
As of January 15, 2022, most health insurance plans cover the cost of up to eight at-home COVID tests per member per month. You’ll want to reach out to your health plan to see exactly how they’re handling this. You may be able to go to a local pharmacy and pick up your tests for free (make sure you have your insurance card with you). Or you may have to purchase the tests and then submit your receipt to your health plan for reimbursement.
Increased access to free at-home COVID testing can provide another layer of security both before and after potential exposure to COVID. These tests can make it easier to meet in person with colleagues, classmates, loved ones, and the general public.
