Overview of Getting At-Home Tests with Insurance

We understand that we have information for very few insurance companies right now. And it is probably really frustrating if cannot find the information you need here. We only have one person working on this. We want to post it even if it's not done so that people can start using the information we do have now.

There are options for free tests in every state. We are currently focusing on building the database on how to access tests with your insurance. In the meantime here are links to some of the options for free tests:

Maryland - you can also check your county's health department's website. For some reason, there might be testing sites on the county sites that aren't on the state site.

Virginia - not all sites with free testing offer it to everybody, contact the site for eligibility

Important information for ALL insurance providers

If doing reimbursement, you will NEED your RECEIPT
At-home tests almost certainly must have FDA EUA
Law for private insurance only covers Diagnostic Tests
- Diagnostic tests are for people who have symptoms of COVID-19. They also are for people who have no symptoms but know or suspect that they have recently been exposed to someone who has COVID-19.
- Does not cover tests for surveillance, employment, school, or social (eg to test before a concert) purposes
Law for private insurance only requires reimbursement of up to $12 per test IF they have a process for having people have no upfront costs. When this applies, we will note this. However, this could change over time.
- “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.”
Generally, there isn't a limit to how many doctor ordered, lab run COVID-19 tests your insurance will cover a month. And these tests will not count towards your 8 at-home over-the-counter test.
- There isn't a limit, but if you take 100 lab tests in a month, somebody might start to wonder if insurance fraud is happening and your insurance will probably try not to cover all 100 and would have a pretty good case that they weren't all medically necessary
Most Medicaid/Medicare Managed Care Organizations are also private insurers. However, the plans are different and have different rules. Thus, if you have Medicaid or Medicare ONLY rely on the information on the Without Private Insurance page

https://www.cms.gov/how-to-get-your-at-home-OTC-COVID-19-test-for-free

Frequently Asked Questions

Please reach us at hopesmedics@protonmail.com if you cannot find an answer to your question.

Is this the same thing as the tests from USPS?

No. These are completely separate.

The USPS tests are the billion free tests the Biden Administration is making available. These tests are 100% free (including shipping) with NO upfront costs. Unfortunately, these tests are limited to 4 per household.

The information on the Hope's Medics site is concerning the 8 tests a month or 30 day period private insurance providers are required to cover. Unless your insurance provider has set up a way where they cover the cost of the tests upfront (most haven't), you will be required to pay for these tests and then your insurance will refund you for your tests.

8 tests a month or 30 day period?

Yes, the law states that private insurance providers are required to cover 8 tests a calendar month or 30 day period. Most insurance providers we have information for so far have chosen to go with 30 day period. This is really important because it means that if you don't buy your first tests right away and then always buy your next set of eight 30 days later, you will be able to get fewer tests overall. However, if your plan chooses to go with every calendar month, you can buy your tests at any point in the month without impacting your ability to access tests in the future.

What's an "at-home" test?

At-home tests are generally agreed to be those where the patient (or family member) collects the sample and runs the test themselves. This is the definition that will be used on this website.

Mail-in PCR testing companies will sometimes call their tests home or at-home tests. They are really the only ones that to though.

What does over-the-counter mean?

Over-the-counter means without a doctor's prescription. For example, you can buy Motrin over-the-counter. The over-the-counter requirement for the 8 tests private insurance companies must cover a month/30 day period means they CANNOT require a prescription for them.

Why do I have to pay upfront?

The law for private insurers tries to encourage insurers to not make you pay upfront by making it slightly less expensive for them to pay for for it upfront than through reimbursement. But it's even cheaper for them to not pay for it at all. If you cannot afford to pay the upfront costs, you won't buy it so they don't have to pay for at-home testing. Insurance companies know this and are using upfront costs to prevent you from accessing test so they don't have to pay for them.

Overview of Getting At-Home Tests with Insurance

Important information for ALL insurance providers

Frequently Asked Questions

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