Coverage for COVID-19 testing

Table of contents

• Coverage information for general COVID-19 testing
• Where to get tested
• Over the counter (OTC) at home tests
• Claims submission and reimbursement for testing
  
  

Coverage information for general COVID-19 testing

Are COVID-19 tests covered?

Yes, but coverage for testing varies by plan. Blue Shield and Blue Shield Promise will cover most COVID-19 tests at no out-of-pocket cost to you for specified plans noted below. This applies to both diagnostic and screening tests.

When are COVID-19 tests covered?

Blue Shield and Blue Shield Promise cover these types of tests:

¹Tests ordered by a healthcare provider means that a licensed and authorized healthcare provider has requested that you obtain a test for COVID-19. For example, a physician, a nurse practitioner, or a physician assistant. These tests can be for diagnostic or screening purposes, such as a screening before a procedure.

²Tests obtained for employment purposes, return to school, or sports are those requested at the direction of an employer, school, or sports league/facility or are for group testing rather than for individual assessment.

³If you receive your health insurance through your employer, association, trust, etc., please contact your employer, plan sponsor, or benefits administrator to see whether you have a fully-insured or a flex-funded group plan. You may also call the customer service phone number on your member ID card.

⁴These can be group plans from employers, associations, trusts, etc. If you receive your health insurance through your employer, plan sponsor, or benefits administrator, review your Blue Shield member ID card for the letters “ASO” (Administrative Services Only) to learn if you are on a self-funded or self-insured plan. Otherwise, contact your employer, plan sponsor, or benefits administrator. You may also call the customer service phone number on your member ID card.

⁵Self-funded group plans are not required to cover these costs. Some may choose to cover screening tests for employment purposes, return to school, or sports. Please refer to your specific benefits or contact your employer, plan sponsor, or benefits administrator for more information.

⁶Neither diagnostic nor screening testing is covered through pharmacy benefits. Therefore, Medicare PDP plans do not cover medical testing. Please check your Original Medicare or Medicare Supplement plan for testing coverage under your medical benefits. Learn how to get free OTC at-home tests through the federal program.
 

Which types of COVID-19 tests are covered?

Blue Shield and Blue Shield Promise cover these types of tests:

Types of tests covered

Out-of-pocket costs may apply

⁷OTC at-home tests are only covered if used for personal use and not for resale. Also, there are some limitations to the number of tests that can be reimbursed without a provider order. See OTC at-home test section for more details.

⁸*Self-funded group plan antibody tests are covered when ordered by a provider unless the group has opted in to offer coverage in alignment with SB 510.

⁹PCR tests (polymerase chain reaction) tests which are generally sent to a lab, but may also include rapid tests such as Nucleic Acid Amplification Tests (NAAT). Learn more about the different types of tests.

¹⁰Tests ordered by a healthcare provider means that a licensed and authorized healthcare provider has requested that you obtain a test for COVID-19. For example, a physician, a nurse practitioner, or a physician assistant. These tests can be for diagnostic or screening purposes, such as a screening before a procedure.

Out-of-pocket costs for COVID-19 testing: in-network vs. out-of-network

¹²When the public health emergency ends, all out-of-network costs not paid by Blue Shield will be your responsibility.

¹³ Other fees unrelated to the administration of the COVID-19 test may be charged for your visit. These may include fees for other tests or services. The member will be responsible for any unrelated fees charged by an out-of-network provider. Learn more about potential out-of-pocket costs from out-of-network providers.

¹⁴Self-funded plans may not cover all of an out-of-network provider’s charges for services related to COVID-19 testing. These amounts not paid by the plan may be the responsibility of the member. Related fees may include specimen collection or processing fees. Learn more about potential out-of-pocket costs from out-of-network providers.
 

If I need to get tested for travel, is that covered?

Domestic travel

Screening tests for domestic travel are covered for most plans. See which plans cover screening tests for travel.

International travel

Coverage for COVID-19 testing outside of the United States depends on your plan benefits and the reason for testing. For some plans, only emergency and urgent care are covered outside of the United States. COVID-19 testing for routine travel does not qualify as urgent or emergency care. However, if you fall ill with COVID-19 symptoms while traveling internationally, testing and treatment may be covered. Proper documentation will need to be submitted.

Please check your Evidence of Coverage or plan policy documents to find out what is covered when traveling internationally. Please remember that COVID-19 testing and vaccination requirements vary worldwide. We highly recommend you review the host country’s COVID-19 requirements before you travel.

Need to get tested?

You have a few options for where to get a test:

1. Use an at-home antigen test, available over-the-counter (OTC) at many retail pharmacies, to screen for employment, school, events, or if you experience symptoms. Learn more about testing.
2. Visit an in-network testing location, like one of these retail pharmacies:
   • CVS pharmacies
   • Rite-Aid
   • Walgreens
   • Quest through Walmart
   • Ralphsʼ Clinic Testing Services for Viral or Rapid Antigen Tests
      

Diagnostic testing performed by out-of-network health care providers is also covered at no cost to members during the public health emergency.

I have a Medicare plan. How can I get a free OTC COVID-19 test?

As of April 4, 2022, the Centers for Medicare & Medicaid Services (CMS) is covering up to eight free OTC COVID-19 at-home tests each calendar month at participating pharmacies and healthcare providers. This benefit is available to Blue Shield and Blue Shield Promise members in the following plans:

• Medicare Advantage
• Medicare Supplement
• Medicare Prescription Drug Plan (PDP) if you also have Medicare Part B coverage

See a list of participating pharmacies.

You should bring your red, white, and blue Medicare card to get your free OTC COVID-19 tests. This applies even if you have another card for your Blue Shield or Blue Shield Promise plan.
 

I have a Medi-Cal plan. How can I get a free OTC COVID-19 test?

As of February 1, 2022, please contact Medi-Cal Rx to locate an in-network pharmacy. You will be able to get an at-home test at no cost through these network pharmacies.

If you purchased an at-home test previously, you may be able to get paid back. If you purchased an OTC at-home test between March 11, 2021, and January 31, 2022, the Department of Health Care Services (DHCS) will reimburse beneficiaries the retail cost with a receipt. See details on the State Medi-Cal website for how to submit a claim.

What are the limits to reimbursement for OTC COVID-19 at-home tests?

Blue Shield provides coverage for OTC COVID-19 at-home tests purchased prior to January 1, 2022, with a healthcare provider order.

As of January 1, 2022, most members can get reimbursed for up to eight OTC at-home tests per member per month without a provider order. Some restrictions apply. For example:

• OTC at-home tests must have been purchased on or after January 1, 2022.
• OTC at-home tests purchased from a private reseller, online auction, or resale marketplace like eBay are not covered.
• OTC at-home tests that are reimbursed by other entities like a flexible spending account (FSA), health savings account (HSA) or health reimbursement account (HRA) or through reselling are not covered.
• If you have a self-funded group plan, OTC at-home tests are not covered or reimbursable if purchased prior to January 15, 2022, without a healthcare provider order, or purchased at any time for employment purposes.
• If you have a Medicare Advantage Plan, you must have a healthcare provider order for your OTC at-home test purchases to be reimbursed by Blue Shield. For more options to get free OTC tests, see details above.
• If you have a Medi-Cal plan, your at-home tests will be covered by your pharmacy benefits. See details above to learn more.

Find out what your coverage is for OTC at-home tests.

My at-home test comes with more than one test per package. Can I get reimbursed for multiple packages?

Each individual test within a package counts as one test. For example, if you purchase a package with two tests inside, that counts as two separate tests. In that case, you would be able to submit reimbursement for up to four packages, or eight tests total, for each member on your plan.

How can I tell if the OTC at-home test is authorized by the Food and Drug Administration (FDA)?

On the test kit package, look for a message that states the test has been authorized for emergency use by the FDA. Some examples of authorized tests include:

See a complete list of authorized tests on the FDA's web page. Type “OTC” or “Home” in the search bar to narrow the results for at-home tests.

Are at-home COVID-19 tests eligible items for reimbursement under an FSA, HSA, or HRA?

Yes, you can use your HSA, FSA, or HRA funds to purchase at-home tests.

However, at-home COVID-19 tests are not qualified medical expenses when the costs are reimbursed by Blue Shield.

Please note that Blue Shield does not offer tax advice for HSAs. HSAs are offered through financial institutions. For more information about HSAs, eligibility, and the law’s current provisions, you should ask you financial or tax adviser, or check with your HSA administrator for more details.
 

How am I reimbursed for at-home tests if I use FSA, HSA, or HRA funds?

You should follow existing claims reimbursement processes to obtain an at-home test reimbursement.

Please note: You cannot be reimbursed more than once for OTC at-home tests. If you intend to seek reimbursement from Blue Shield, it is recommended that you do not use an FSA, HSA, or HRA debit card to purchase at-home tests.

Similarly, for at-home tests paid for or reimbursed by Blue Shield, you should not seek reimbursement from an FSA, HSA, or HRA for the cost (or the portion of the cost). As such, Blue Shield does not deposit any reimbursements directly into an FSA, HSA, or HRA.

If you mistakenly receive reimbursement from an FSA, HSA, or HRA for at-home test costs covered by Blue Shield, you should contact the FSA, HSA, or HRA administrator. They can advise you on how to return the money back into your account.

Please note that Blue Shield does not offer tax advice for HSAs. HSAs are offered through financial institutions. For more information about HSAs, eligibility, and the law’s current provisions, you should ask your financial or tax adviser, or check with your HSA administrator for more details.

Claims submission and reimbursement for all COVID-19 testing

How can I submit a claim form for my OTC COVID-19 at-home tests?

For eligible plans, you can fill out and mail a paper claim form. You may also submit a digital claim online with a copy of your receipt.

Using a paper claim form allows you to submit reimbursement for multiple purchases and for multiple members at the same time.

If you use the online form, you must file a separate digital claim for each member and for each receipt.

You will only be reimbursed for the maximum allowable tests per member per month for your plan.

See details for how to submit a claim for reimbursement for covered testing.

Find out what your coverage is for OTC at-home tests based on your plan.

Medi-Cal members: Do not submit any claims to Blue Shield Promise.
 

I paid out-of-pocket for a COVID-19 test that should be covered. What do I need to do?

If you paid the provider at the time of your appointment, the healthcare provider should give you a refund after Blue Shield reimburses them. If you did not receive a refund from your provider, please contact their office.

If your provider has not submitted a claim to Blue Shield for you, visit our How to file a claim page to learn more.
 

For out-of-network providers:

Some out-of-network providers may charge added fees. Please choose in-network locations for testing to avoid paying any extra fees

Test-related fees: Most plans cover all fees related to the administration of the COVID-19 test during the public health emergency. Some self-funded group plans may not cover all the costs when seeing an out-of-network provider. Members are responsible for any fees or tests that are not covered by their plan.

Unrelated fees: These are other fees that may be charged for your visit, but are unrelated to the test itself. These may include fees for other tests or other services unrelated to the COVID-19 test. Members may have out-of-pocket costs for unrelated fees, depending on their plan benefits. To avoid paying any extra fees, please use network locations for testing.

We will mail you an explanation of benefits that outlines what Blue Shield paid and what remaining balance you may owe, if any. Please be aware that this statement is not a bill.

Coverage for out-of-network testing will change when the public health emergency ends.
 

I received a check from Blue Shield. What should I do with it?

If you haven’t yet paid the provider, the check goes to the provider. Contact the provider to find out how they want to be reimbursed.

Please note that if you have previously visited an out-of-network provider and received a check payment from Blue Shield, our process has changed. Those payments will now go directly to the provider. The provider should mail you a refund check.

We will mail you an explanation of benefits that outlines what Blue Shield paid and what remaining balance you may owe. Please be aware that this statement is not a bill.
 

Have more questions about testing coverage?

Call the customer service number on your member ID card.