How to get your At-Home Over-The-Counter COVID-19 Test for Free | CMS

Beginning January 15, most people with a health plan can go online, to a pharmacy or in-store to purchase a government-approved over-the-counter COVID-19 home diagnostic test. ee uu. Food and Drug Administration (FDA) at no cost, either through reimbursement or free through your insurance. This applies whether you bought your health plan on your own or get health insurance through your job.

the test will be free directly at the point of sale, if your health plan provides direct coverage, or through reimbursement if you are charged for the test. Be sure to save your receipt if you need to file a claim with your insurance company for reimbursement. If your plan has established a network of preferred providers where you can get a test at no out-of-pocket cost, you can still get tests from other retailers outside of that network. insurance companies are required to reimburse you at a rate of up to $12 per individual test (or the cost of the test, if it is less than $12).

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1. Will I have to pay for my test in advance?

The biden-harris administration is strongly encouraging health plans and insurers to establish a network of convenient locations across the country, such as pharmacies or retail stores, where people with private health coverage will be able to order online. online or pick up over-the-counter covid-19 home tests for free, instead of going through the process of having to file claims for reimbursement. Consumers can find out from their plan or insurer if they provide direct coverage of over-the-counter COVID-19 tests through that program or if they will need to file a claim for reimbursement. If you are charged for your test after January 15, save your receipt and file a claim with your insurance company for reimbursement.

1. How much will I be reimbursed for a over-the-counter covid-19 home test if I purchase the test in advance and then submit a claim for reimbursement to my carrier? safe?

If you buy an over-the-counter COVID-19 test from a pharmacy, store, or online retailer and are charged for your test, save your receipt and submit a claim to your insurance company for reimbursement. If your plan has not established a network of preferred stores, pharmacies, and online retailers where you can get a test at no out-of-pocket cost, you will be reimbursed for the cost of the test. For example, if you buy a pack of two tests for $34, the plan or insurer will reimburse you $34.

If your plan has established a network of preferred stores, pharmacies, and online retailers where you can get a test at no out-of-pocket cost, you can still get tests from other retailers if you buy them outside of that network. a fee of up to $12 per individual test (or the cost of the test, if less than $12). save your receipt(s) to submit to your reimbursement plan at a rate of at least $12 per individual test (or the cost of the test, if less than $12).

1. Why would these companies be incentivized to cover the cost up front?

if a plan or insurer establishes a network of convenient options, such as pharmacies or retailers, including online retailers, where people on their plans can cover the cost of their tests in advance (at the point of sale) , then it is permissible to limit the amount of reimbursement per trial for retailers outside of that network. specifically, if a plan or insurer establishes this type of direct coverage option, then the plan or insurer may limit reimbursement for tests purchased outside of its network to $12 per test (or the actual price of the test, if less) . many commercially available home tests cost around $12 or less per test.

If the plan or insurer does not establish a process through which individuals can obtain the test with no upfront costs, then the plan and insurer must reimburse the full cost of the test, even if the test costs more than $12 . For example, if a person buys a two-pack for $34 and the plan or insurer has not set up a system to cover costs up front, then the plan or insurer would have to reimburse the $34 instead of $24.

1. Where can I find a place that has over-the-counter covid-19 home tests?

Consumers can visit stores online or in person. The Biden-Harris Administration is also strongly incentivizing health plans and insurers to establish a nationwide network of convenient options, such as pharmacies or retailers, including online retailers, where people can get COVID-19 tests. free of charge at the point of sale, rather than having to file claims for reimbursement. Consumers can check with their plan or insurer if they provide direct coverage of over-the-counter COVID-19 testing through that network of preferred retailers or pharmacies.

1. What if I can’t pay for over-the-counter covid-19 home tests up front?

Health plans and insurers are strongly incentivized to establish a nationwide network of convenient options, such as pharmacies and retailers, where people will be able to order online or pick up at home without a prescription. free covid-19 tests instead of going through the process of having to submit claims for reimbursement. Consumers can check with their plan or insurer if it provides direct coverage of over-the-counter covid-19 tests through that network of preferred retailers or pharmacies.

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You can also access free trials in the community. you can find a list of community based testing sites here. COVID-19 tests are also available at no cost share to covered individuals when administered by a health care provider such as a nurse, doctor, or pharmacist, without limitation.

1. What if I don’t have insurance? can i still get free home covid-19 tests without a prescription?

the biden-harris administration is purchasing 500 million over-the-counter home tests to distribute for free to all Americans who want them, with initial delivery starting in January 2022. there will be a website where americans can request home tests for home delivery, free. more information about this federal program is expected soon.

People without insurance can also get free home testing at some community health centers.

in addition, the u.s. the department of health and human services (hhs) is providing up to 50 million free at-home tests to community health centers and medicare-certified health clinics for distribution at no cost to patients and community members community. The program aims to ensure that COVID-19 testing is available to populations and settings that need testing, especially populations at higher risk for adverse outcomes related to COVID-19. As of December 21, 2021, all Health Resources and Services Administration (HRSA)-supported health centers (including look-alikes) and Medicare-certified rural health clinics are eligible to participate in the program after complete the onboarding process. More information about this program is here.

hhs has also established more than 10,000 free community pharmacy testing sites across the country. To respond to the surge in Omicron, the Department of Health and Human Services (HHS) and the Federal Emergency Management Agency (FEMA) are creating surge testing sites in states across the country.

1. What if I already bought and paid for over-the-counter covid-19 home tests? can I still get a refund for that?

Plans and insurers must cover over-the-counter COVID-19 home tests purchased on or after January 15, 2022. -Over-the-counter covid-19 home tests purchased before January 15. Contact your health plan for information on how to get reimbursed for tests purchased before January 15, 2022. Some states may have existing requirements related to coverage of over-the-counter home tests. -covid-19 test counter.

1. What happens if I buy more than one test at a time?

Your plan must provide reimbursement for 8 tests per month for each individual on the plan, regardless of whether the tests are purchased all at once or at separate times throughout the month.

If your plan has established a network of convenient options, such as pharmacies and retailers, where people can cover the cost of their tests in advance (at the point of sale), then the plan may limit reimbursement for tests tests. purchased outside of your network at $12 per test (or the actual price of the test, if less than $12). If more than one test is purchased or ordered at a time, such as a two-test package, the insurer will reimburse up to $12 for each test purchased at that time.

1. If I pay in advance, how do I get reimbursed?

If you are charged for your test, save your receipt and submit a claim to your health plan for reimbursement. You can find out how to submit claims for reimbursement directly from your plan. they are not allowed to design their refund process in a way that unduly delays your refund. you won’t need a prescription or a note from your provider.

1. How long will it take to receive reimbursement from my plan?

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Health plans are encouraged to provide prompt reimbursement for home testing claims, and consumers can find out directly from their plan how their claims process works and ask questions about reimbursement timing.

The biden-harris administration is strongly incentivizing plans to offer over-the-counter COVID-19 home testing through preferred pharmacies, retailers, and online and mail-order programs at no out-of-pocket cost to you. . . Consumers can find out from their plan if it provides such direct coverage of over-the-counter covid-19 tests. you will not need to request reimbursement later for proofs received through such a program.

1. How many tests can I be reimbursed for?

Health plans must cover 8 individual over-the-counter covid-19 home tests per person enrolled in the plan per month. that means a family of four can get 32 ​​tests per month for free.

Please note that tests can be packaged individually or with multiple tests in one package (for example, two tests packed in one box). plans are required to cover 8 tests per covered person per month, regardless of how they are packaged and distributed.

There is generally no limit on the number of COVID-19 diagnostic tests, including home tests, that must be covered when ordered or administered by a health care provider.

1. My employer requires that I be tested several times a week and submit the results to them as a condition of employment. Can I get my insurance to reimburse me for these tests?

Plans are not required to provide testing coverage (including an in-home, over-the-counter covid-19 test) for work purposes.

1. I am covered by medicare. how do i get an over-the-counter covid-19 test at home?

hhs provides up to 50 million free home tests to community health centers and medicare-certified health clinics for distribution at no cost to patients and community members. you can learn more about this program here. hhs has also established more than 10,000 free community-based pharmacy testing sites across the country. To respond to the Omicron surge, HHS and FEMA are creating surge test sites in states across the country. the biden-harris administration is purchasing 500 million over-the-counter home tests to distribute for free to americans who want them, with initial delivery starting in january 2022. there will be a website where all americans can order at -home tests for home delivery—free. more information about this federal program is expected soon.

for people covered by original fee-for-service medicare, 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 doctor, not -doctor, pharmacist or other authorized health professional. people with medicare can access one lab-based test at no cost-sharing per patient per year without an order. at this time, original medicare cannot pay for home testing through this program. Medicare Advantage plans may offer coverage and payment for over-the-counter in-home COVID-19 testing, so consumers covered by Medicare Advantage should check with their plan.

1. Do state medicaid and chip programs cover home testing for covid-19?

According to the American rescue plan, state Medicaid and chip programs are required to cover fda-authorized home covid-19 tests. People with Medicaid or CHIP coverage should contact their state Medicaid or CHIP agency for information on coverage details for in-home COVID-19 testing, as coverage rules may vary by state.

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