Over-the-counter COVID-19 testing coverage: What you need to know

By Regence

Access to COVID-19 testing continues to be a critical component of public health and safety, enabling our members to navigate the pandemic. Through new guidance issued by the federal government public health emergency, beginning April 4, 2022, Medicare members with Medicare Part B coverage, including those enrolled in a Medicare Advantage plan, can get up to eight free over-the-counter (OTC) at-home COVID-19 tests per month at eligible pharmacies or other participating entities through the federal public health emergency with no provider prescription required.

The new guidance allows Medicare members to get tests at no cost and will not need to be reimbursed, as the Centers for Medicare and Medicaid Services (CMS) will pay the pharmacy or other entity directly for tests bought on or after April 4, 2022. To get your free tests, bring your red, white, and blue Medicare card with you (even if you have a Medicare Advantage or Medicare Part D plan), in case the pharmacy needs your Medicare information.

Current information on participating pharmacies and health care providers as well as current information on Medicare and covered COVID-19 services can be found on the Medicare.gov Coronavirus page.

Through guidance issued by the federal government in January, Regence commercial members are covered for up to eight diagnostic over-the-counter (OTC) COVID-19 tests per month, with no provider prescription required starting Jan. 15, 2022, through the federal public health emergency. The guidance allows eligible commercial health plan members to be reimbursed for up to eight OTC at-home tests per person age 2 and older per month to be used for diagnostic reasons, meaning the person has symptoms or was exposed to someone with COVID-19. You may be asked to affirm that the test is used for that purpose. The policy does not extend to coverage of tests used for employment, surveillance, tracking, or activities such as travel or sports.

Visit your local in-network pharmacy to buy a test, and the pharmacy can bill insurance directly at no cost to you. You can also buy a test online or at another retail location and submit a claim for reimbursement from your health plan. For tests bought at a location other than an in-network pharmacy, Regence will reimburse up to $12 per test.

If you have not yet taken advantage of the free tests from the federal government, visit this website. Every home in the U.S. is eligible to order 2 sets of 4 free at-home tests.

Visit regence.com to read more information about diagnostic OTC COVID-19 test coverage, including an FAQ, plus other important health plan information. Regence members can also call us using the phone number on the back of their member ID card. We’re here to help.

The Capital Benefit Services team is proud to assist you in offering affordable health insurance benefits to your employees and their families. To find out more about Capital Benefit Services call us at 425-641-8093.

Disclaimer: This information is not intended to be a substitute for professional medical advice. Please seek the advice of a qualified medical professional before beginning or ending medical treatment or if you have questions regarding a medical condition.

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