OTC tests for COVID-19 covered at $0 cost share starting Jan. 15, 2022

Starting January 15, we’ll cover over-the-counter (OTC) diagnostic COVID-19 tests (FDA approved) at $0 cost share for our commercial group and individual members, without a prescription.

This is in addition to existing coverage for our Medicaid members who can receive at-home tests at $0 cost share with a prescription and in accordance with the Medicaid Policy

Who doesn’t this coverage apply to?

This coverage does not apply to our Medicare Advantage members. OTC tests are also not covered for use in employment or public health surveillance.

How many tests are covered?

Covered individuals can receive 8 OTC tests within a 30-day period.

Where can members buy tests?

Wherever they’re available. OTC tests purchased at the pharmacy counter will be covered with no out-of-pocket expense. If a member gets an OTC test somewhere other than the pharmacy counter (i.e., the regular checkout line), they’ll need to pay for the tests and can then submit a claim for reimbursement at a rate of up to $12 per individual test.

Does this impact COVID tests ordered by my practice?

No. COVID testing ordered by a health care professional when the test is medically necessary to diagnose and treat a patient’s symptoms continues to be covered 100%, with no member cost sharing applied and no limit to the number of tests.

Get more information

If your patients have questions, they can find information online. Additionally, the federal government will begin accepting orders for free at-home tests on Jan. 19, 2022 online at COVIDtests.gov.