The Biden-Harris Administration is strongly incentivizing health plans and insurers to set up a network of convenient locations across the country such as pharmacies or retailers where people with private health coverage will be able to order online or walk in and pick up at-home over-the-counter COVID-19 tests for free, rather than going through the process of having to submit claims for reimbursement.  Consumers can find out from their plan or insurer if it provides direct coverage of over-the-counter COVID-19 tests through such a program or whether they will need to submit a claim for reimbursement. If you are charged for your test after January 15, keep your receipt and submit a claim to your insurance company for reimbursement.

From the CMS Goverment Website

Medicare covers and pays for eight (8) over-the-counter (OTC) COVID-19 tests at no cost to people with Medicare Part B, including those with Medicare Advantage (MA) plans. If you are not a Medicare member, or do not have Part B, please check with your health insurance provider for further information.

Reimbursement for over-the-counter COVID-19 at-home test kits

Earlier this week, the Biden-Harris Administration announced new federal guidelines that require private health insurance plans to cover the costs for over-the-counter COVID-19 diagnostic tests purchased on or after Jan. 15, 2022.

The new coverage requirement means that members of Paramount employer-sponsored or Marketplace health plans can go online or to a pharmacy or store, buy a test, and either get it paid for up front by Paramount or get reimbursed for the cost by submitting a claim to Paramount.

• Based on the guidelines provided by the Biden administration, Paramount will cover up to eight over-the-counter at-home COVID-19 tests per 30-day period for each person covered under your plan.
• Tests must be approved, cleared or authorized by the U.S. Food and Drug Administration.
• You can only get reimbursed for tests purchased on Jan. 15, 2022 or later.
• These tests don’t require an order from your physician to qualify for reimbursement.
• Tests must be used to diagnose a potential COVID-19 infection. Tests used for employment, school or recreational purposes are not eligible for reimbursement.

Note: This new coverage reimbursement policy doesn’t apply to members who have Paramount Medicare, Medicare Supplement or Medicaid health plans.

Learn more about COVID at-home test kit reimbursement.
View COVID resources for Paramount members.

If a plan or insurer sets up a network of convenient options such as pharmacies or retailers, including online retailers, in which individuals on their plans can get their tests’ cost covered up front (at the point of sale), then it is permitted to limit the per test reimbursement amount for retailers outside of that network. Specifically, if a plan or insurer establishes this type of direct coverage option, then the plan or insurer is permitted to limit the reimbursement for tests purchased outside of their network to $12 per test (or the actual price of the test, if less). Many commercially available at-home tests run about $12 or less per test.

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

The Biden-Harris Administration is purchasing 500 million over-the-counter at-home tests to be distributed for free to all Americans who want them, with the initial delivery starting in January 2022. There will be a website where Americans can request at-home tests for home delivery—for free. More information on this federal program is expected soon.

People without insurance can also get free at-home test from some community health centers.

In addition, the U.S. 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. The program is intended to ensure COVID-19 tests are made available to populations and settings in need of testing, especially populations at greatest risk from 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 completing the on-boarding process. More information about this program is here.

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

Additional information about testing resources for people without insurance are available here: https://www.hhs.gov/coronavirus/covid-19-care-uninsured-individuals/index.html.  More Info

It started April 4, 2022, and continues until the COVID-19 public health emergency (PHE) ends. People with Medicare Part B can get up to eight free over-the-counter tests each subsequent calendar month through the end of the COVID-19 PHE.

Yes, this is a Medicare initiative. Medicare will cover up to eight over-the-counter COVID-19 tests each calendar month, at no cost to you. Starting April 4, 2022, and through the end of the COVID-19 public health emergency(PHE), Medicare covers and pays for 8 over-the-counter (OTC) COVID-19 tests, every calendar month. For more info on the initiative, please see the following link: https://www.cms.gov/newsroom/fact-sheets/medicare-covers-over-counter-covid-19-tests

No. You will not need to change pharmacies. We simply mail you your tests each month and you would still use your regular pharmacy for all other needs.

No, Per this Medicare initiative, we only accept the Medicare payment amount as payment in full and do not collect any additional amounts from patients for tests provided within the quantity limit.

No. Medicare coverage and payment began on April 4, 2022, and is available for up to eight over-the-counter COVID-19 tests per calendar month you receive from a participating pharmacy or health care provider after the initiative started. Medicare will not provide payment for over-the-counter COVID-19 tests obtained prior to April 4, 2022.

Starting April 4, 2022, this initiative covers up to eight over-the-counter COVID-19 tests each calendar month. If you’ve gotten eight of these tests in the current calendar month, you will need to wait until the beginning of the next calendar month to get more tests. For example, if you receive eight over-the-counter COVID-19 tests on April 14, 2022, through this initiative, you will not be eligible for another round of eight free over-the-counter COVID-19 tests until May 1, 2022. Note that there can be multiple tests per box, so eight tests may come in fewer than eight boxes.