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Insurance Coverage for Over-the-Counter COVID-19 Tests
As of January 15, 2022, private health insurers are required to cover up to eight at-home COVID-19 diagnostic tests per month for each person covered by a health plan. Tests must be authorized by the U.S. Food and Drug Administration (FDA) in order to be covered.
To meet this requirement, insurers may choose to provide direct coverage for tests by:
- Establishing a program to have tests mailed directly to you upon request, or
- Establishing a network of preferred providers that will enable you to go directly to a designated pharmacy or retailer to obtain free tests.
If your insurer does not provide direct coverage, or if you purchase tests outside of your insurer's preferred provider network, you can request reimbursement for some or all of your out-of-pocket expense.
DIFS has surveyed health insurers operating in Michigan and prepared the information below to help Michiganders understand this benefit and how it will be offered. This information is provided for informational purposes only. Check with your insurer for the most up-to-date information for your specific plan. Coverage should always be confirmed with your plan prior to purchasing any tests. DIFS is not responsible for any costs incurred in reliance on this information.
If your insurer has a network of preferred providers:
- You can get up to eight at-home COVID-19 tests per month for every person covered on your health plan. For example, if four people are covered by your health plan, you can get up to 32 tests per month.
- These tests are available without out-of-pocket cost at locations specified by your insurance company.
- If you purchase a test at a retailer or pharmacy that is outside your insurer's preferred provider network, your insurance company will reimburse you up to $12 per test, or the cost of the test if less than $12. If your tests cost more than $12 per test, you will not be reimbursed for the difference.
- Insurers may not apply deductibles, co-pays, or other cost sharing to at-home COVID-19 tests purchased under this new benefit.
- For information about your insurer's network of preferred providers and reimbursement process, see the information below.
If your insurer does not have a network of preferred providers:
- You can get up to eight at-home COVID-19 tests per month for every person covered on your health plan. For example, if four people are covered by your health plan, you can get up to 32 tests per month.
- You will have to pay for your tests up front and should save your receipts and test boxes for submission to your insurance company for reimbursement.
- Your insurance company will reimburse you for the full purchase price of each covered test.
- Insurers may not apply deductibles, co-pays, or other cost sharing to at-home COVID-19 tests purchased under this new benefit.
- For information about your insurer's reimbursement process, see the information below.
If you purchased at-home COVID-19 tests prior to January 15, 2022:
Insurers are not required to provide coverage for COVID-19 tests that were purchased prior to January 15, 2022. However, insurers may choose to reimburse consumers for these tests. See the information below to determine if your insurer is reimbursing for these tests.
If you're a Medicare or Medicaid Participant:
For information about insurance coverage for at-home COVID-19 tests, please see the Centers for Medicare and Medicaid Services FAQ.
All Michiganders are eligible to order free at-home COVID-19 tests from the federal government at COVIDTests.gov.
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Aetna Life Insurance Company
COVID-19 Testing Coverage Website:
https://www.aetna.com/individuals-families/member-rights-resources/covid19/otc-in-home-test-faqs.htmlPhone Number:
Members should call the number on the back of their ID card.Network of Preferred Providers:
Contact the company for the latest information.Reimbursement Process Link or Description:
Members will have the option of online submission through the secure member website or sending a paper submission. Estimated reimbursement is within 30 calendar days.
Information requested will include:- Subscriber identification and dependent information
- Type of tests and quantities purchased
- Legible copies of UPC codes and receipts including date purchased
- An attestation stating for member use only, not for resale or work/school/travel related testing
Reimbursement for tests purchased before January 15, 2022:
No -
Ambetter from Meridian
COVID-19 Testing Coverage Website:
https://www.ambettermeridian.com/coronavirus/covid-19-home-testing-kits.htmlPhone Number:
833-993-2426 (Relay 711)Network of Preferred Providers:
A direct link to the Ambetter provider search tool is given for members to find a pharmacy from the COVID-19 home test kit page: https://guide.ambetterhealth.com.Reimbursement Process Link or Description:
Members will receive test kits from network pharmacies at no cost. If a member purchases a kit from an out-of-network provider or retailer, the member must submit a “member reimbursement form”. The instructions and form are provided on the COVID-19 home test kit page: https://www.ambettermeridian.com/coronavirus/covid-19-home-testing-kits.html.Reimbursement for tests purchased before January 15, 2022
Yes. -
Blue Cross Blue Shield of Michigan
COVID-19 Testing Coverage Website:
www.bcbsm.com/coronavirusPhone Number:
Members should call the number on the back of their ID card.Network of Preferred Providers:
Tests are available at the pharmacy counters of Meijer, Walmart, Walgreens, Rite Aid and Sam's Club stores.Reimbursement Process Link or Description:
To request reimbursement for a fully self-administered FDA authorized test purchased from a non-preferred pharmacy or other retailer between January 15, 2022 and January 31, 2022, submit this form:
https://www.bcbsm.com/content/dam/public/shared/documents/coronavirus/covid-testing-member-reimbursement-form.pdfTo request reimbursement for a fully self-administered FDA authorized test purchased from a non-preferred pharmacy or other retailer after January 15, 2022, submit this form:
https://covidtest.optumrx.com/covid-test-reimbursementReimbursement for tests purchased before January 15, 2022:
Yes, with a provider order. -
Cigna
COVID-19 Testing Coverage Website:
www.cigna.com/coronavirusPhone Number:
800-997-1654 (main)Network of Preferred Providers:
NoReimbursement Process Link or Description:
Effective January 15, 2022 and thru the end of the Public Health Emergency (PHE), OTC tests that are approved under the FDA Emergency Use Authorization In Vitro Diagnostics EUAs - Antigen Diagnostic Tests for SARS-CoV-2 | FDA will be covered at $0 cost to the customer, without a health care provider order or individualized clinical assessment. If you purchase an over-the-counter COVID-19 test from a pharmacy, store, or online retailer and are charged for your test, keep your receipt and submit a claim to Cigna for reimbursement. You will be reimbursed the costs of diagnostic OTC testing, regardless of where the tests are obtained (in- or out-of-network). Your plan will provide this coverage through reimbursement to you. Your plan may require you to sign an attestation that the test was purchased:- for the covered individual;
- is not for employment purposes;
- has not and will not be reimbursed by another source, and
- is not for resale.
Your plan may require reasonable documentation of proof of purchase with a claim for reimbursement for the cost of an OTC COVID-19 test. Examples of such documentation could include the UPC code for the OTC COVID-19 test and/or a receipt from the seller of the test, documenting the date of purchase and the price of the OTC COVID-19 test.
Reimbursement for tests purchased before January 15, 2022:
for tests purchased on or after January 15, 2022. Submit a claim online, or download the COVID-19 Over-the-Counter (OTC) Test Kit Claim Form [PDF] and submit via mail or fax using the instructions on the form. -
Health Alliance Plan (HAP)
COVID-19 Testing Coverage Website:
https://www.hap.org/covid19-coronavirus/at-home-covid-19-rapid-testing-kitsPhone Number:
800-422-4641 (main)Network of Preferred Providers:
Contact the company for the latest information.Reimbursement Process Link or Description:
https://www.hap.org/covid19-coronavirus/at-home-covid-19-rapid-testing-kitsReimbursement for tests purchased before January 15, 2022:
No -
Humana
COVID-19 Testing Coverage Website:
https://www.humana.com/coronavirus/coverage-faqsPhone Number:
800-448-6262 (main)Network of Preferred Providers:
Members may now purchase through the preferred network online at CVS.com using their insurance card. Or purchase in-store at an in-network pharmacy counter with their Humana ID card as outlined in the FAQ.Reimbursement Process Link or Description:
https://www.humana.com/coronavirus/coverage-faqsReimbursement for tests purchased before January 15, 2022:
Contact the company for the latest information. -
McLaren Health Plan Community
COVID-19 Testing Coverage Website:
https://www.mclarenhealthplan.org/mhp/are-you-a-memberPhone Number:
888-327-0671 (TTY 711)Network of Preferred Providers:
At in-network pharmacies.Reimbursement Process Link or Description:
Members can submit a direct member reimbursement claim to McLaren using the form found by following the link: https://www.mclarenhealthplan.org/community-member/materials-mhp/direct-member-reimbursement-7049.
Claims must include proof of purchase (e.g. prescription receipt and UPC Code from the packaging) and other information reasonably requested by McLaren to validate payment.
Members can also contact Customer Service at 888-327-0671 (TTY: 711). Please note that tests are currently in short supply and some retailers may impose limits on the number of tests you can purchase.Reimbursement for tests purchased before January 15, 2022:
No -
Molina Healthcare of Michigan
COVID-19 Testing Coverage Website:
https://www.molinamarketplace.com/Marketplace/MI/en-us/Coronavirus.aspx/Phone Number:
888-560-4087Network of Preferred Providers:
Yes, CVS Caremark PharmaciesReimbursement Process Link or Description:
https://www.molinamarketplace.com/Marketplace/MI/en-us/Coronavirus.aspx/Reimbursement for tests purchased before January 15, 2022:
No -
Oscar
COVID-19 Testing Coverage Website:
https://www.hioscar.com/at-home-covid-test-reimbursementPhone Number:
855-672-2788Network of Preferred Providers:
https://www.hioscar.com/search/facilities?specialty_id=3336C0003X&network_id=017&year=2022&zip_code=49444&searchUrl=https%3A%2F%2F
www.hioscar.com%2Fsearch%2F%3FnetworkId%3D017%26year%3D2022Reimbursement Process Link or Description:
https://www.hioscar.com/at-home-covid-test-reimbursementReimbursement for tests purchased before January 15, 2022:
No -
Paramount
COVID-19 Testing Coverage Website:
https://www.paramounthealthcare.com/news/reimbursement-for-over-the-counter-covid-19-at-home-test-kitsPhone Number:
419-887-2525 (main)
Toll free: 800-462-3589Network of Preferred Providers:
Contact the company for the latest information.Reimbursement Process Link or Description:
https://www.paramounthealthcare.com/covid-19/at-home-covid-testing-kitsReimbursement for tests purchased before January 15, 2022:
No -
Physician's Health Plan (PHP)
COVID-19 Testing Coverage Website:
https://www.phpmichigan.com/?id=175&sid=1Phone Number:
For Commercial/HMO inquiries, please call 517-364-8500 or (toll-free) 800-832-9186.
For Sparrow Health System inquiries, please call 517-364-8432 or (toll-free) 877-275-0076.
For PPO/Insurance Company inquiries, please call 517-364-8456 or (toll-free) 800-203-9519.
For Marketplace inquiries, please call 517-364-8567 or (toll-free) 866-539-3342.Network of Preferred Providers:
Yes, CVS pharmaciesReimbursement Process Link or Description:
Members will be required to fill out a COVID-19 self-test claim submission sheet and submit it via us mail along with UPC packaging label and receipt.
For more information, visit https://www.phpmichigan.com/?id=175&sid=1.Reimbursement for tests purchased before January 15, 2022:
No -
Priority Health
COVID-19 Testing Coverage Website:
https://www.priorityhealth.com/covid-19Phone Number:
800-942-0954 (main)Network of Preferred Providers:
Contact the company for the latest information.Reimbursement Process Link or Description:
https://www.priorityhealth.com/covid-19/vaccineReimbursement for tests purchased before January 15, 2022:
No -
UnitedHealthcare
COVID-19 Testing Coverage Website:
https://www.uhc.com/health-and-wellness/health-topics/covid-19/coverage-and-resources/covid-19-at-home-testing-coveragePhone Number:
Members should call the number on the back of their ID card.Network of Preferred Providers:
https://www.uhc.com/health-and-wellness/health-topics/covid-19/coverage-and-resources/covid-19-at-home-testing-coverageReimbursement Process Link or Description:
https://www.uhc.com/health-and-wellness/health-topics/covid-19/coverage-and-resources/covid-19-at-home-testing-coverageReimbursement for tests purchased before January 15, 2022:
No -
US Health and Life Insurance Company
COVID-19 Testing Coverage Website:
Contact the company for the latest information.Phone Number: 586-693-4400 (main)
Network of Preferred Providers:
Contact the company for the latest information.Reimbursement Process Link or Description:
Contact the company for the latest information.Reimbursement for tests purchased before January 15, 2022:
Contact the company for the latest information.
Consumers who have questions or concerns that cannot be directly resolved with their insurer can contact DIFS Monday through Friday 8 a.m. to 5 p.m. at 877-999-6442 or file a complaint online at Michigan.gov/DIFScomplaints.