Does Insurance Cover COVID Tests and the Rules You Need to Know

If you're wondering whether insurance covers COVID tests, the answer is yes, but with some caveats. In the US, the Families First Coronavirus Response Act requires most health insurance plans to cover COVID-19 testing without cost-sharing.

Many insurance plans are now covering at-home COVID tests, but the rules vary. Some plans may require a doctor's order or a visit to the doctor's office to get a test covered.

Private insurance companies are also providing coverage for COVID tests, but the specifics depend on your plan. Some plans may cover tests for people who are showing symptoms, while others may cover tests for people who have been exposed to someone with COVID.

Most types of health insurance used to cover at-home COVID test kits without a prescription or doctor's order, but that changed when the COVID public health emergency ended in May 2023.

Prior to January 15, 2022, health insurance plans only covered at-home COVID tests if they were prescribed by a doctor and deemed medically appropriate.

In January 2022, the restriction was removed, allowing people to get at-home COVID tests without a prescription or doctor's order.

Medicare coverage of at-home COVID testing didn't start until April 2022, but it followed the same coverage requirement as other health plans.

Now that the public health emergency has ended, most health insurance plans no longer cover at-home COVID tests, but some may still offer this coverage.

Medicaid coverage for COVID testing, including at-home tests, continues through September 2024, but details vary by state.

If you have Medicaid, you should contact your state Medicaid agency or Medicaid managed care organization for details on how many tests are covered and where to obtain them.

Health plans that aren't considered health insurance, such as health care sharing ministry plans, didn't have to cover the cost of at-home COVID tests.

Original Medicare no longer covers at-home COVID tests, but Medicare Advantage plans have the option to cover them or not.

People with most types of health insurance can no longer get free at-home COVID tests through their health plan, except for those with Medicaid, who can contact their state Medicaid office or Medicaid managed care plan for details.

However, the federal website that shipped free COVID tests directly to Americans' homes is temporarily accepting orders again as of September 2023, but it's unclear how long this will continue. Some programs may still be available to provide free COVID tests to uninsured people and underserved communities.

At-home COVID tests are still widely available for purchase at pharmacies, retail stores, and online, but you'll generally have to pay for them out-of-pocket.

At-home COVID tests can be purchased for as little as $8 or $10 for a single test, and two-pack test kits start at about $15 to $18, depending on where you purchase them.

The price of at-home COVID test kits depends on the brand, whether it's a multi-pack or a single test, whether it also tests for the flu, and where you purchase it.

You can expect to pay out-of-pocket for at-home COVID tests, unless you have a medical flexible spending account (FSA) or a health savings account (HSA), in which case you can use the money in the account to purchase the tests.

Using FSA or HSA funds to buy at-home COVID tests is a good option if your health plan is no longer covering the cost of at-home COVID tests, which is the case for most people now that the public health emergency has ended.

Medicare coverage of at-home COVID testing did not begin until April 2022, but it was only for people with Original Medicare, and Medicare Advantage plans have the option to cover them or not.

Some health plans may continue to provide coverage for at-home COVID tests, but most no longer do so, so it's a good idea to contact your health plan to see if they still offer any sort of coverage.

You can also contact your state Medicaid agency or Medicaid managed care organization if you're enrolled in Medicaid, as they will vary in terms of how many tests are covered and where enrollees can obtain them.

Commercial/Individual & Families (ACA) plans have undergone changes in COVID-19 testing coverage due to the Public Health Emergency (PHE) ending on May 11, 2023.

Aetna's standard policy covers testing for infectious disease as part of the rate for the surgical procedure, with no separate member cost share for the infectious disease testing included in the surgical procedure rate.

Most Aetna plans will cover COVID-19 diagnostic testing with standard benefit cost sharing for plans with in and out of network benefits, including doctor's offices, clinics, labs, and pharmacies where available.

Benefit cost sharing means you may have to pay a portion of the diagnostic testing cost through your deductible, copay, or coinsurance.

You can log in to your secure member website to review your specific Aetna plan and coverage information and search for local in-network providers.

Select drive-thru locations, including CVS Pharmacy, Walgreens, and Rite Aid, may also be available for COVID-19 diagnostic lab tests.

Aetna private, employer-sponsored, and student health commercial insurance plans covered up to eight over-the-counter (OTC) at-home COVID-19 tests per 30-day period for each person covered under your plan, until the end of the public health emergency on May 11, 2023.

Insurers are required to reimburse members for up to eight at-home COVID-19 tests, but only if obtained "in-network" with your insurer.

If you have Aetna coverage through your employer or an individual and family plan, you may have to pay a portion of the diagnostic testing cost through your deductible, copay, or coinsurance.

Anthem Blue Cross still reimburses members for up to eight at-home tests, but you need to check your plan to see if this applies to you.

For Aetna Medicare Advantage plan members, COVID-19 diagnostic lab tests are covered in-network with no cost share.

Aetna Medicaid coverage waives member cost share for diagnostic testing related to COVID-19.

Insurers like Anthem Blue Cross have their own rules, so make sure to check your plan before buying a test to see what's covered.

Anthem Blue Cross still requires reimbursement for up to eight at-home COVID-19 tests, but only if purchased in-network. This rule applies to California residents due to state law.

Insurers like Aetna have changed their rules, and most no longer cover at-home COVID tests for free. However, Aetna Medicare Advantage members continue to pay $0 in-network for diagnostic lab testing.

Original Medicare no longer covers at-home COVID tests, but Medicare Advantage plans have the option to cover them or not. This means some plans may continue to provide this coverage, while others do not.

Medicaid coverage for COVID testing, including at-home tests, continues through September 2024, so people enrolled in Medicaid should contact their state Medicaid agency or Medicaid managed care organization for details.

Aetna Medicaid coverage waives member cost share for diagnostic testing related to COVID-19. This means Medicaid members won't have to pay out-of-pocket for COVID-19 testing.