Needing A Home COVID Test? Learn What NC Health Insurers Will Cover

And a recent change to federal policy is aimed at making at-home tests more accessible and affordable by guaranteeing they’re covered by health insurance.

Here’s what you need to know about which tests are covered and how to find them:

Does health insurance have to cover COVID tests?

Federal officials announced Monday a new requirement for “insurance companies and group health plans to cover the cost of over-the-counter, at-home COVID-19 tests.”

The new plan, which takes effect Saturday, “means that most consumers with private health coverage can go online or to a pharmacy or store, buy a test, and either get it paid for up front by their health plan, or get reimbursed for the cost by submitting a claim to their plan,” the Department of Health and Human Services said in a statement.

The tests must be “authorized, cleared, or approved” by the FDA, the statement added, and the plan specifically covers up to eight at-home tests “per covered individual per month.”

The Children’s Health Insurance Program and Medicaid programs were already required “to cover FDA-authorized at-home COVID-19 tests without cost-sharing,” according to HHS.

Medicare covers COVID-19 lab tests ordered by a doctor, pharmacist “or other authorized health care professional.”

Which North Carolina health insurance companies cover COVID tests?

Here are the COVID testing coverage policies for some of the major health insurance providers that serve North Carolina:

Aetna CVS Health is covering the cost of COVID-19 testing. The company is also “waiving member cost-sharing for diagnostic testing related to COVID-19,” meaning no out-of-pocket costs for members.

Blue Cross Blue Shield of NC is covering the cost of “COVID-19 tests performed in labs or at-home” that are FDA approved. To be covered, members must have “undergone an Individualized Clinical Assessment,” and the test “must be issued by a licensed or authorized health care provider or a licensed or authorized provider must refer an individual to take the test.”

Cigna “is waiving out-of-pocket costs for COVID-19 FDA-approved testing.” Members who “have gone out-of-network and received an unexpected bill for a COVID-19 diagnostic visit or test” should call the helpline number on their ID card to rectify the issue.

Humana members “will be eligible for COVID-19 testing with no out-of-pocket costs” when the test is ordered “by a physician or other licensed health care professional” because the member is symptomatic, has been exposed to someone with COVID, or needs a test before another medical procedure. There will be “no out-of-pocket cost” for Humana Medicare Advantage and Medicaid members for COVID testing so long as the test is FDA approved.

United Healthcare is covering the cost of COVID-19 testing if the test is FDA approved and “medically appropriate,” meaning it has been “ordered or reviewed by a health care professional” for someone who is symptomatic, has been exposed to COVID or needs medical treatment.

Medicare “pays for COVID-19 diagnostic tests performed by a laboratory, such as PCR and antigen tests, with no beneficiary cost-sharing when the test is ordered by a physician, non-physician practitioner, pharmacist, or other authorized health care professional,” according to the Centers for Medicare and Medicaid Services. “Medicare-certified health clinics” also offer free at-home tests, and some Medicare Advantage plans may cover the cost of at-home testing.

All state Medicaid programs, including North Carolina’s, “are required to cover FDA-authorized at-home COVID-19 tests,” per the Centers for Medicare and Medicaid Services.

How to get at-home COVID tests

Over-the-counter tests can be purchased at various pharmacies, online retailers and other stores, though some have experienced shortages.

Some drive-up sites in Mecklenburg County offer free at-home tests for pick up “while supplies last.”

The federal government also plans to mail out 500 million over-the-counter, at-home tests for free starting this month. A website for requesting tests will be launched “soon,” according to HHS.

How to get reimbursed for COVID tests

If you buy at-home COVID tests on or after Jan. 15, you should save your receipt and submit a claim to your insurance company. Then, you will be reimbursed for the full cost of the tests, up to eight tests per person, per month.

Some health insurance companies may have “a network of preferred stores, pharmacies, and online retailers at which you can obtain a test with no out-of-pocket expense,” HHS adds.

Insurance companies are not obligated to reimburse customers for the cost of tests purchased before Saturday, HHS said, though some health insurance companies may have already been covering the cost of testing before the policy change.

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