Covid Tests Kits through Insurance?
December 4, 2022 7:26 PM   Subscribe

The federal requirement seems to be that we're all entitled to 8 Covid test kits a month, covered by insurance. I tried to obtain some today when I got a booster, but the pharmacist said she couldn't get it to go through my insurance. I know there's a reasonable chance this is specific to my insurance, but does anyone have guidance or suggestions?
posted by lapis to Health & Fitness (16 answers total) 2 users marked this as a favorite
It seems to be highly variable. My local independent pharmacist has been easily able to do it since shortly after the policy change was announced, while Walgreens (at least locally in Madison, WI) was like here is a receipt, good luck!
posted by rockindata at 7:44 PM on December 4, 2022 [2 favorites]

Response by poster: (Sorry, should have specified: US)
posted by lapis at 7:49 PM on December 4, 2022

I’ve ordered them online through a link in my insurance company’s website.
posted by chesty_a_arthur at 7:58 PM on December 4, 2022 [3 favorites]

Call the member services phone number, usually on the back of your card, and ask which pharmacies are contracted to provide free tests. My insurer offered Rite Aid and Walmart, Duane Reade (NYC chain) and a few others I've never heard of, which I assume are Western or Southern pharmacies. You can ask at other independent pharmacies, but it will probably be hit or miss with them. There is also a reimbursement option, but I've not tried to purchase tests this way.

In the beginning of this program Medicare was not eligible, but that has changed.
posted by citygirl at 8:00 PM on December 4, 2022 [2 favorites]

Assuming it's a big chain, try going to the website of your pharmacy. Some of them will have a page to order them "for free" with your insurance.
posted by praemunire at 8:02 PM on December 4, 2022 [1 favorite]

Certain insurers have agreements with specific pharmacy chains. For instance, my Moda policy will not allow me to get these at a CVS and charge directly to insurance, but it will allow me to at Walgreens. The other option is I can pay out of pocket at CVS or wherever and file a claim with Moda for reimbursement but it takes forever to get it. I would call different pharmacy chains and ask each whether they are able to dispense the rapid antigen tests to you and charge your particular insurance provider.

I have also found that for places that do charge the insurance on my behalf, I don't get to choose which brand of test. So again, if the brand is important to you, that would be a good secondary question to ask any pharmacy that says they can charge your insurance directly.

(I also ordered some through Costco's mail-order pharmacy online and they charged my insurer directly, but NOTE that they sell them in 5-packs so I could only get 5 tests a month that way. Something to be aware of.)
posted by happy_cat at 8:08 PM on December 4, 2022

I think we get ours through Sam's Club (or Costco) so that could be another option.

The 8 free tests are mandated by the federal government in the US.
posted by jclarkin at 8:09 PM on December 4, 2022 [1 favorite]

I tried to get the 8 free tests through my pharmacy (Walgreens) but was declined. I was able to purchase them out of pocket and receive a reimbursement check via my insurance company (Blue Shield of California). I received a check in several weeks after filing an online claim.
posted by zombiedance at 8:55 PM on December 4, 2022 [1 favorite]

Best answer: Probably depends on your HMO. I have to order mine off their webpage and they send 4 at a time, so I order another set every other week. You will probably have to poke around your HMO's website or do some strategic Googling to figure out how your HMO handles it. Mine seems to have yanked working through pharmacies (they wouldn't let me get a vaccine through one again this go-round), so that's not a guarantee that yours will permit it. My HMO never reimbursed me for the tests I had to buy before they put it on the website either, sigh.
posted by jenfullmoon at 10:05 PM on December 4, 2022

I have United Health Care PPO, and I have successfully obtained reimbursements for buying them at my local drugstore. I can also apparently order them through the UHC website via some online pharmacy partnership situation they have set up.
posted by desuetude at 10:16 PM on December 4, 2022 [1 favorite]

I have Blue Cross, and they refused to reimburse when I bought tests on Amazon right after they announced the 8 free tests a month thing. I order them from my pharmacy benefits place, Express Scripts. They are reasonably happy to send my family of four 32 tests each time I ask them to (which has been 4 or 5 times now). It’s probably about time to order more, actually. But the most recent round of tests they sent didn’t seem to be as high-quality. One of the dropper bottles in the test didn’t work (nothing would dispense out) and the test cartridge didn’t seem to be behaving properly.
posted by leahwrenn at 10:45 PM on December 4, 2022

Best answer: This is indeed specific to your insurance, and I would check their website and/or call them for more information. Insurers are required to cover the 8 tests a month per person, but there are multiple ways they can choose to do that.

They can have a "network of preferred stores, pharmacies, and online retailers" where you can get tests with no out-of-pocket costs. That's where you run into the "it works at Walgreens but not CVS" or vice-versa issues, and checking with your insurer should clarify what those preferred locations are. If your insurance company has set up that network, you can also buy tests from anywhere and submit a request for reimbursement up to $12/test (max 8/person/month as usual, and that's 8 tests even if they come 2 to a box or whatever). There are a variety of tests now available from major internet retailers that cost less than that, so you could order those and then figure out whatever (probably cumbersome and slow) procedure your insurance company has to request that reimbursement.

If your insurance company hasn't setup a network like this—and a bunch have chosen not to—you can buy the tests from anywhere and submit a request for reimbursement, and they're required to reimburse the actual cost of the tests. This has the downside that you have to pay up front and wait for reimbursement, but the upside that you can buy what you want from wherever you want it.
posted by zachlipton at 11:42 PM on December 4, 2022 [2 favorites]

Best answer: My insurance (Blue Cross Blue Shield of my state) won't cover the cost at point of sale, but I can submit a reimbursement form, the original receipt, and the bar codes from each box. I did this in October and it took them about 3 weeks to mail me the reimbursement check. One point to be aware of is: not all brands of tests are covered. My insurance provides a list online of ones that ARE covered, which I literally printed and took with me into Walgreens. I'm fortunate that I can cover the cost of the tests until I get reimbursed.
posted by csox at 6:12 AM on December 5, 2022

As others have mentioned, this really depends on the pharmacy. I have had 0 luck getting them for free at my two walking-distance CVS pharmacies. They both say I need to purchase and then ask my insurance for reimbursement. But the pharmacy in my walking-distance grocery store does it no problem. I have a friend who has successfully gotten their local CVS (about 5 miles from mine) to do it through their insurance, though it took a little extra asking, from what I remember.

In my experience this is a CVS policy rather than something related to my insurance. I was told to purchase and ask for reimbursement from my insurance by the CVS pharmacists without me giving them my name or insurance info, so they would have had no idea whether or not was directly covered by my insurance.

Just speculation, but I'd guess CVS gets more money if you purchase and then get reimbursed from your insurance rather than have them bill your insurance. US health/prescription insurance is an inscrutable mystery to me.
posted by msbrauer at 6:14 AM on December 5, 2022

Personally I've been ordering them from Amazon and getting reimbursed (through Cigna). Cigna has a special form for this. It's not too bad. They mail me checks, I'm not sure how long they take, maybe a couple weeks.
posted by bfields at 6:56 AM on December 5, 2022

Response by poster: Thanks, all. This was really helpful in figuring out that the insurance company is entity in the process I should be researching. The company's website says that they're expecting people to pay out of pocket and then fill out a (five-page) reimbursement request, so that's what I shall do.

Thanks again!
posted by lapis at 9:06 AM on December 5, 2022 [1 favorite]

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