How to Submit Your At-Home COVID Test to Your Insurance Company

The federal government announced earlier this month that private health insurance companies will be required to cover up to eight at-home COVID-19 tests per person per month. The ruling went into effect on January 15, meaning individuals covered under a private health insurance plan—either as group coverage or individual coverage—should theoretically now be able to test themselves for COVID-19 at home for free.

That said, getting a test covered by your insurer can be complicated. Every health insurance plan approaches coverage differently—some will cover the cost of your test upfront, while others will reimburse you for the fee if you file a claim for the test.

The reality is that the process of getting your test paid for, either up front or after the fact, will be difficult for some, patient health advocates warn. "The more steps involved in any process, the greater the barrier," Caitlin Donovan, senior director of public relations at the National Patient Advocate Foundation, tells Health. "In this case, the barriers are notable: There's no set process in place, and information has been fragmented."

Also worth noting: Not everyone has the money to buy a test out of pocket and wait for the reimbursement from their insurance company, Donovan explains. That means many people in the US without disposable income—which could be as many as half of all Americans, according to The Balance—will have difficulty benefitting from this new coverage requirement. "I suspect only a minority of people who could be reimbursed for tests will take advantage of that system," says Donovan.

The reimbursement process itself can be quite a hassle, too. Regardless of how much disposable income someone has, they might forego their reimbursement simply because they don't want to have to bother with it, Adria Gross, CEO of MedWise Insurance Advocacy, tells Health. "The question for many people is whether this is financially worth it for them," she says. "Are you going to go ahead and try to fight for your money or decide it's not worth it?"

Though submitting your at-home test to insurance might be cumbersome, it's still important to know how to get your money back—or how to have your insurer pay for a test up front—should you decide that's what you want to do. Here's what to know about the leg work involved on your end.

How to determine which option your insurer uses

Unfortunately, this partinvolves a little detective work. "Different insurers will have different processes for reimbursement," Donovan says.

Kaiser Family Foundation(KFF), a health policy nonprofit, published a breakdown of how 13 major health insurance companies are handling reimbursements for at-home COVID tests:

• Anthem: reimbursement with an online form
• Blue Cross Blue Shield of Michigan: reimbursement with receipts and a mail-in form
• Blue Shield of California: reimbursement with receipts and a mail-in form
• Blue Cross Blue Shield of North Carolina: direct coverage
• Care First: reimbursement with receipts and a mail-in form
• Centene/Ambetter: direct coverage
• Cigna: reimbursement with receipts and a mail-in (or faxed) form
• CVS Group/Aetna: reimbursement
• Guidewell (Florida Blue): direct coverage
• Health Care Service Corporation: direct coverage
• Humana: direct coverage
• Kaiser Permanente: reimbursement with an online form
• United Health Group: direct coverage

Donovan recommends checking your insurance company's website or calling the number on the back of your insurance card to find out whether your company is paying up front or reimbursing, adding that some insurers are asking customers to hang on to their receipts and "stay tuned" because they haven't yet decided how they're going to handle coverage.

How to take advantage of direct coverage for at-home tests

Data from KFF shows that six of the 13 major health insurance companies offer what is known as "direct coverage" of COVID-19 at-home tests, meaning the company will pay for the test at the point of purchase and not make you jump through the hoops of filing for reimbursement.

That said, you should double check to see if you can get your test for free at your preferred pharmacy before you head out to buy one. That's because, in order to give you direct coverage of a COVID test, carriers have pre-chosen a preferred network of pharmacies, retailers, or mail-order options for the tests. If you purchase a test outside of your preferred network, your insurance company can cap your reimbursement fee at $12—meaning that even if your COVID test costs upwards of $30, you will still only receive a $12 reimbursement.

If you find an at-home COVID test while you're out shopping and you're not sure if the store you're in is in your health insurance company's preferred network, Donovan suggests asking the store employee at the check out counter if your insurance plan will cover the test before putting any cash down. For this reason, it's important to keep your health insurance card on you if you're in the market for a test: The employee will probably need to use it to look up whether or not you can walk out without paying for the test.

How to submit a reimbursement claim for at-home tests

If your insurance company requires you to file for reimbursement by mail—like seven of the 13 major insurance companies do, per KFF—you'll have to do a bit more work on your own. That means finding the reimbursement form online (Donovan recommends Googling your health insurance company and "at-home COVID test reimbursement" to locate the form), printing it out, filling it out, and sending it in—either by mail or via fax.

The reimbursement forms for each insurance company will look different, but they'll usually ask for information like your subscriber ID, group number, any contact information (name and address), and then the information of whoever bought the test (if it's someone other than yourself). You may also need to provide additional information, including: your reason for buying the test, the test manufacturer, where the test was purchased, and the date of purchase.

In addition to providing that information on the form, you may also have to attach a receipt indicating how much you paid for the test, and the UPC code on your test's box—this will allow your carrier to verify that your at-home test is authorized by the FDA, which is a requirement for reimbursement.

Also important: If multiple members of a family on the same insurance plan order tests on their own, each member who wants a reimbursement must submit their own claim. You won't be able to submit multiple tests, bought by multiple people, on the same reimbursement form.

Some insurers make things a bit easier by allowing people to submit their reimbursement forms online. In that case, you should be able to fill out the form and submit it on the insurance copmany's website, without printing out a physical copy. However, you will likely be asked to scan a copy of your receipt and submit that online—or send it to a specified email address—as well, Donovan says.

In general filing for reimbursement is more of a hassle than is receiving direct coverage, Donovan says, adding that she hopes this changes soon: "I'm hopeful that, over time, more insurers will set up networks so that their members can go into their local pharmacy and pick up a test for free, whenever they need it."

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDC, WHO, and their local public health department as resources.