If you need a rapid at-home COVID-19 test and have private health insurance, starting on Jan. 15 your insurer will pay for up to eight tests a month for you and anyone else covered under your health plan.
This new federal government requirement comes as the COVID-19 omicron variant has propelled the number of U.S. coronavirus cases to the highest level ever, with 797,216 new cases reported by the Centers for Disease Control and Prevention (CDC) on Jan. 12. As cases mount, consumers also find that at-home tests are increasingly difficult to find — and expensive.
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Many pharmacies and other stores have taped signs to their front doors that say: “No COVID Tests.” And early in January, a major national grocer was selling a single test online for $49.99, according to Lindsey Dawson, an associate director at the Kaiser Family Foundation. That’s more than twice what these tests have been costing.
In addition to the coverage insurers will provide, a federal website is projected to be up and running this month that will have 500 million free at-home tests available to mail to any American who requests them. And President Joe Biden announced on Jan. 13 that the federal government will be purchasing another 500 million tests.
Missing from the new testing plan: older adults covered by original Medicare.
“At this time original Medicare cannot pay for at-home tests through this program,” says a federal fact sheet outlining the plan’s specifics. Enrollees covered by Medicare Advantage plans should check with their plans to see if they will cover the cost of the test. Medicare beneficiaries will be able to get free tests at some community health centers or through the federal website when it launches. Officials at the Centers for Medicare and Medicaid Services (CMS) have not said why Medicare is not part of the free-test program.
But Medicare advocates say beneficiaries shouldn’t have to rely on the federal website or community health centers. “These tests can be cost-prohibitive,” says David Lipschutz, associate director of the Center for Medicare Advocacy. “If one orders online, how long does it take to send tests to individuals who request them?” he asks, and “what about people without internet access — this would still require an in-person trip or a willing family member or friend” to help them get the tests.
Rapid at-home tests, also known as antigen tests, provide results in 15 minutes, compared to the several days it can take to hear back about PCR — polymerase chain reaction — testing, but PCR tests are generally considered more accurate. The rapid tests are typically sold in boxes of two.
Ten tips for getting at-home tests:
- Can I get these tests for free at a store as of Jan. 15? Check with your health plan to see if it will pay directly for at-home tests if you pick them up in person at a pharmacy or another store. If you do have that coverage, you can go to a store and get the tests for free.
- What if my plan requires me to pay up front? Keep your receipts and submit claims to your insurance company. Check with your plan to see if you can email a copy of your receipt, or if you should download a form and mail in your proof of purchase.
- How much is an insurance company required to pay? It must reimburse you up to $12 per individual test, or the full cost of the test, if that’s less than $12.
- Can I get reimbursed if I bought an at-home test before Jan. 15? You can check with your insurer to see if it will pay for tests you bought before the program began. Some states already provide free rapid tests to some or all of their residents, including Colorado, Maryland, New Hampshire, Ohio, Oregon and Washington. New York City is offering free fast-turnaround PCR testing.
- Will there be enough at-home tests to go around? “Availability is very scarce right now,” says Dawson at the Kaiser Family Foundation. “Manufacturing is a key piece for this to work.” Administration officials say they are working with manufacturers to ramp up test production.
- How many free tests can I obtain? You can get eight individual tests for free per month per person enrolled in the health plan. That means that if you have a family of five on your coverage, you can get 40 tests for free each month. Your plan must provide the same reimbursement whether you buy eight tests at once or at different times during the month.
- What if I want more than eight tests per month? You may be able to get them through the federal website or from community health centers the federal government is providing tests to. The rules governing how many tests Americans can get mailed to them through the website have not yet been released.
- What if my employer requires that I get tested several times a week? Health plans do not have to cover testing for employment. Check if your employer will provide tests. You can also go online and order free tests from the federal website once it is up and running.
- What if I’m on Medicare? Federal officials are providing up to 50 million free at-home tests to Medicare-certified health clinics and community health centers. If you are enrolled in a Medicare Advantage plan, check with that plan to see if it will pay for tests. Medicare enrollees can also use the federal free-test website when it’s up and running.
- What if I’m uninsured? You can get tests for free by mail via the website that federal officials plan to launch this month or go to a community health center.
Deborah Schoch is a contributing writer who covers health and science. A longtime journalist, she has most recently reported for AARP and The New York Times.