Insurance companies must now cover cost of at-home COVID tests. Here's how it works. [The Charlotte Observer]
As of
Under the rule, insurance providers are required to cover the cost, either through reimbursement or up front at the pharmacy counter, of eight tests per insurance-covered individual per month.
This requirement is being implemented in addition to another federal government initiative that allows each household address in the
But the process of actually having your test covered by insurance will require you to make sure the pharmacy where you purchase your test is in-network, or submit a claim to your insurance for reimbursement.
That means the process will vary based on which insurance provider you have.
To make the process easier to understand, we've broken down what you should know about the program overall, using information from the
Here's what you need to know.
What types of COVID tests are covered under the program?
The new program will cover the cost of at-home, over-the-counter COVID-19 diagnostic tests that are authorized by the
CareStart COVID-19 antigen home test
Flowflex COVID-19 antigen home test
BD Veritor at-home COVID-19 test
Celltrion DiaTrust COVID-19 Ag home test
Cue COVID-19 Test for home and over-the-counter (OTC) use
Detect Covid-19 test
Ellume COVID-19 home test
iHealth COVID-19 antigen rapid
Lucira CHECK-IT COVID-19 test kit
InteliSwab COVID-19 rapid test
QuickVue at-home OTC COVID-19 test
QuickVue at-home COVID-19 test
How will my insurance cover the cost of the tests?
The federal government is requiring insurance providers to cover test costs either through making them free for you at the test's point of sale (generally in-store at a pharmacy) or through reimbursement.
To receive a test at no initial cost to you at the point of sale, you will need to purchase your test at a pharmacy that is preferred by or in-network with your insurance provider.
The exact process for having your test covered at an in-network point of sale may vary by insurance company, but in general, you would simply be required to present your insurance card or member ID when you check out and purchase your test.
Check with your insurance provider to see which pharmacies are in-network on your plan to ensure your test will be covered at the point of sale.
If you purchase a test at a pharmacy that is not in-network with your insurance, you can pay for the test out-of-pocket, then submit a claim to your insurance company for reimbursement.
If your insurance has set up a network of preferred pharmacies, you will be eligible for reimbursement of up to
If your insurance has not set up a network of preferred pharmacies, you will be eligible for reimbursement of the full cost of your tests. For example: If you purchase a pack of two tests for
If you need to claim reimbursement, make sure you save all of your receipts from purchasing tests. You will need to submit the receipts with your claim.
Can I buy more than one COVID test at a time?
The new federal requirement requires insurance plans to cover eight tests per insured individual per month, regardless of whether the tests are bought all at once or at separate times throughout the month.
If you need to claim reimbursement for your tests, you would still be able to claim up to
If your insurance plan has not set up a network of preferred pharmacies, you would be eligible for reimbursement of the full cost of each individual test, regardless of how many you purchase at one time.
The eight tests per person per month limit applies only to at-home tests you purchase yourself. Tests ordered or administered by a health care professional during or following a clinical assessment do not count towards the eight-test limit.
Where can I find at-home COVID tests?
At-home, over-the-counter COVID tests are sold at a variety of pharmacies and other stores, including CVS, Walgreens and Walmart.
What if I'm self-insured?
The federal program requires all private health insurance companies and group plans to cover tests, whether you are self-insured and purchased insurance coverage on your own or you are insured through your employer.
What if I purchased a test prior to
The federal program only requires insurance providers to cover the cost of tests purchased on or after
Insurance companies may, but are not required to under federal law, provide coverage for at-home, over-the-counter COVID tests purchased before
Getting your tests covered: Blue Cross and Blue Shield NC customers
Find
Blue Cross NC will accept claims for reimbursement for tests purchased at out-of-network pharmacies.
To submit a claim for reimbursement under Blue Cross NC:
Save your purchase receipt documenting the date of purchase and the price of the test.
Save the test's UPC code.
Mail the completed form, receipts and UPC code to Prime Therapeutics, Mail route: Commercial. PO Box 25136,
Upon receipt of the required materials, Prime Therapeutics will issue a reimbursement check to you, typically within 21 days.
If the back of your Blue Cross NC member ID card doesn't list Prime Therapeutics as your prescription drug plan, you may have a different pharmacy benefit manager. If this is the case, ask your employer or benefits manager about your testing reimbursement options.
Find more information about COVID-19 test coverage under Blue Cross NC at bluecrossnc.com/covid-19/covid-19-testing.
Getting your tests covered:
Find
You can submit a claim to
Find out more about COVID-19 test coverage offered by
Getting your tests covered:
If you have a third-party pharmacy benefits manager under your
Getting your tests covered: Cigna
Cigna's website advises people insured by Cigna to submit claims for reimbursement for any at-home, over-the-counter tests, whether they are purchased in- or out-of-network.
You can find the Cigna reimbursement claim form and additonal instructions at cigna.com
Keep your receipts for the test and submit them with your claim. Your specific Cigna plan may also require you to submit proof of purchase information, including the test's UPC code.
Find more information about Cigna's test coverage at cigna.com/coronavirus.
Getting your tests covered: Medicare
If you are insured under Medicare, you are not eligible to have at-home, over-the-counter COVID tests covered at the point of sale or through reimbursement.
The federal
Find out more about the federal DHHS program at hrsa.gov/coronavirus/testing-supplies.
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