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:
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.