Does BCBS Cover Covid Tests and How to Get Reimbursed

Blue Cross Blue Shield (BCBS) does cover COVID-19 tests, but the specifics can be confusing.

BCBS covers COVID-19 tests for both in-network and out-of-network providers, but you may need to pay a copayment or coinsurance.

If you're an in-network provider, you may not need to pay anything out of pocket for a COVID-19 test.

BCBS requires a doctor's order for a COVID-19 test, and some plans may have specific requirements for test coverage.

BCBS covers most COVID-19 tests at no out-of-pocket cost to members for specified plans. This applies to both diagnostic and screening tests.

Individuals and families with Blue Shield plans, small business plans, and Medicare Supplement plans are eligible for coverage. They can get up to eight FDA-authorized, self-administered, self-read, at-home COVID-19 tests per month at no cost.

Medicare Advantage members with Medicare PPO Blue SaverRx and Medicare HMO Blue SaverRx plans can also use their quarterly OTC allowance to buy COVID-19 tests at no out-of-pocket cost. However, if they've already met their quarterly allowance, they'll have to pay out-of-pocket for their tests until the start of the next quarter.

Self-funded group plans also offer coverage for COVID-19 tests, but the specifics depend on the plan. Some self-funded plans may not cover all out-of-network provider charges for services related to COVID-19 testing.

Medicare Prescription Drug Plan (pharmacy benefit only) does not cover COVID-19 tests, as testing is not covered through pharmacy benefits.

Here are some key points to remember about BCBS COVID test coverage:

If you're a BCBS member, you're in luck because they cover OTC at-home COVID-19 tests.

You can get these tests at no cost if you have a Medicare plan, specifically Medicare Advantage, Medicare Supplement, or Medicare Prescription Drug Plan (PDP) with Medicare Part B coverage. Just bring your red, white, and blue Medicare card to a participating pharmacy or healthcare provider.

BCBS also covers OTC at-home tests for up to eight tests per member per month, but some restrictions apply. For example, the tests must have been purchased on or after January 1, 2022, and not from a private reseller or online marketplace.

Some examples of authorized tests include the Ellume COVID-19 Home Test, Flowflex COVID-19 Antigen Home Test, and QuickVue At-Home OTC COVID-19 Test. You can find a complete list of authorized tests on the FDA's website.

If you have an FSA, HSA, or HRA, you can use your funds to purchase at-home tests, but you can't be reimbursed more than once for OTC at-home tests.

To submit a claim form for reimbursement, you can fill out a paper claim form or submit a digital claim online with a copy of your receipt. You can submit reimbursement for multiple purchases and for multiple members at the same time.

Here's a list of some examples of authorized tests:

If you purchased an FDA-authorized test and paid out of pocket, you can get reimbursed by submitting a Health Benefits Claim Form with an itemized receipt or the barcode (UPC code) from your test packaging.

If you're covered by Blue Shield, you can use your HSA, FSA, or HRA funds to purchase at-home COVID-19 tests. However, if you intend to seek reimbursement from Blue Shield, it's recommended that you don't use an FSA, HSA, or HRA debit card to purchase at-home tests.

Reimbursement for at-home tests is a bit tricky, so make sure to follow the existing claims reimbursement processes. If you receive reimbursement from an FSA, HSA, or HRA for at-home test costs covered by Blue Shield, you should contact the FSA, HSA, or HRA administrator to return the money back into your account.

To submit a claim form for your OTC COVID-19 at-home tests, you can fill out and mail a paper claim form or submit a digital claim online with a copy of your receipt. The type of COVID-19 tests covered by Blue Shield varies by plan, but most plans cover OTC at-home tests, standard PCR tests, rapid point-of-care antigen tests, and antibody tests, with some limitations and exceptions.

COVID-19 tests are covered by Blue Shield, but the extent of coverage varies by plan.

If you receive your health insurance through your employer, association, trust, etc., you'll need to contact your employer, plan sponsor, or benefits administrator to determine whether you have a fully-insured or flex-funded group plan. This information can also be found on your Blue Shield member ID card.

Tests ordered by a healthcare provider are covered, including those for diagnostic and screening purposes. This includes tests for individuals with symptoms, as well as those without symptoms.

Diagnostic tests are covered for individuals and family plans, small business plans, Medi-Cal plans, Medicare Supplement plans, and fully-insured or flex-funded group plans. These plans also cover screening tests for contact-tracing, known or suspected exposure, employment, return to school, or sports.

Medicare Advantage plans cover diagnostic and screening tests, but not tests for employment, return to school, or sports. Self-funded group plans may cover diagnostic and screening tests, but coverage for tests for employment, return to school, or sports is uncertain.

Medicare Prescription Drug Plan does not cover medical testing, including COVID-19 tests.

Here is a summary of when COVID-19 tests are covered:

If you've purchased OTC COVID-19 at-home tests, you may be eligible for reimbursement. You can fill out and mail a paper claim form or submit a digital claim online with a copy of your receipt.

To submit a claim, you'll need to provide an itemized receipt that clearly shows your purchase was for a COVID-19 OTC test. If you don't have an itemized receipt, you can send the barcode (UPC code) from your test's packaging.

You can download the claim form or call the number on the back of your member ID card to receive one by mail. You can submit a digital claim for each member and for each receipt, but you'll only be reimbursed for the maximum allowable tests per member per month for your plan.

Here are some authorized OTC at-home tests that are eligible for reimbursement:

You can also submit a claim for reimbursement for covered testing through Blue Shield's website. If you paid the provider at the time of your appointment, the healthcare provider should give you a refund after Blue Shield reimburses them.