OCI > Insurance Coverage for at-Home COVID-19 Tests

Insurance Coverage for at-Home COVID-19 Tests

Last Updated: September 6, 2022

As of January 15, 2022, all health plans are required to cover the cost of up to eight at-home COVID-19 diagnostic tests per month for each member of the plan. Tests are counted individually, not per box – i.e., four boxes with two at-home tests each equals eight tests. At-home tests may either be free or reimbursed by the insurer.

To provide this coverage, insurers may choose to set up a network of pharmacies or retailers that will enable you to go directly to a designated pharmacy or retailer to obtain free, at-home tests. If your insurer does not establish a network of pharmacies or retailers, or if you purchase tests outside of your insurer's preferred provider network, you can request reimbursement for some or all of your out-of-pocket expense.

Check with your insurer for the most up to date information for your specific plan. Confirm your coverage before you purchase any tests.

If your insurer has a network of preferred providers:

You can get up to eight at-home COVID-19 tests per month for every person covered on your health plan. For example, if four people are covered by your health plan, you can get up to 32 at-home tests per month.
At-home tests are available without out-of-pocket cost at locations specified by your insurance company.
If you purchase an at-home test at a retailer or pharmacy that is outside your insurer's network of pharmacies or retailers, your insurance company will reimburse you up to $12 per at-home test, or the cost of the test if less than $12. If your at-home tests cost more than $12 per test, you will not be reimbursed for the difference.
Insurers may not apply deductibles, co-pays, or other cost sharing to at-home COVID-19 tests purchased under this new benefit.

If your insurer does not have a network of preferred providers:

You can get up to eight at-home COVID-19 tests per month for every person covered on your health plan. For example, if four people are covered by your health plan, you can get up to 32 at-home tests per month.
You will have to pay for your at-home tests up front and should save your receipts and test boxes for submission to your insurance company for reimbursement.
Your insurance company will reimburse you for the full purchase price of each covered at-home test.
Insurers may not apply deductibles, co-pays, or other cost sharing to at-home COVID-19 tests purchased under this new benefit.

If you're a Medicare or BadgerCare Plus member:

Members of BadgerCare Plus and most Wisconsin Medicaid programs can get at-home, rapid COVID-19 tests from Medicaid-enrolled pharmacies without having to pay. Learn more here.
See the Centers for Medicare and Medicaid Services FAQ

If you're uninsured:

All Wisconsinites are eligible to order free at-home COVID-19 tests from the federal government at COVIDTests.gov .
The state of Wisconsin has teamed up with Vault Medical Services to offer COVID-19 tests for everyone who lives in Wisconsin, with or without symptoms, at no cost. This service allows people to collect their own saliva samples at home and send them to a laboratory for testing. Visit COVID-19: At-Home Collection Kit to learn more.
The Wisconsin Department of Health Services launched an online program for Wisconsinites to get free at-home rapid COVID-19 tests delivered directly to them. Wisconsin residents can go to the Say Yes! COVID Test website and place an order for a package of five rapid antigen COVID-19 tests at no cost. Initial supplies will allow each household to order one package that will arrive in 1-2 weeks.

Additional Information

If you purchased at-home COVID-19 tests prior to January 15, 2022:

Insurers are not required to provide coverage for at-home COVID-19 tests that were purchased prior to January 15, 2022. However, insurers may choose to reimburse consumers for these at-home tests. Check with your insurer for details.

Excluded COVID-19 Test Types

Only at-home COVID-19 tests purchased for personal use on or after January 15, 2022, will be covered.

The following tests are excluded from coverage:

At-home tests to meet employer requirements, such as testing in lieu of vaccination.
At-home tests for public health surveillance (i.e., not to diagnose a specific condition).
At-home tests that are not specifically for you or a covered dependent.
Laboratory diagnostic (sometimes called PCR tests) and antibody tests still require orders from a doctor to be covered.

Questions or Concerns

If you have questions or concerns about your insurance company or agent, contact the insurance company or agent involved. Keep a record of the conversations you have. If you do not receive satisfactory answers, you may contact the Office of the Commissioner of Insurance to file a complaint.