Are At-Home COVID-19 Tests Covered By Insurance?

With new variants emerging, at-home COVID-19 tests are becoming more widespread within various drug stores. However, their costs have remained an issue for many Americans. In general, health insurance companies do not cover the cost of an at-home COVID-19 test.

Mira offers an affordable alternative health coverage option. Additionally, with Mira, you can receive access to urgent care and virtual care visits, lab testings, and up to 80 percent off on thousands of prescriptions. Sign up today!

At-Home COVID-19 Tests

In most scenarios, if you were to go to a drug store and purchase an at-home COVID-19 test, it likely won’t be covered by insurance. However, if a doctor specifically orders the test for you, your health insurance plan could potentially cover this cost.

This is because legislation that was put in place early in the pandemic said that an at-home COVID-19 test falls within the health insurance coverage requirement if it “is ordered by an attending healthcare provider who has determined that the test is medically appropriate for the individual.” Essentially, if your doctor believes that a COVID-19 test is critical and can be performed at home, you can submit a claim to your health insurance to help cover the cost.

Below is a table with commonly used at-home COVID-19 tests and their respective prices. 

Rapid Antigen Tests

At-home rapid antigen tests work by detecting proteins on the surface of the SARS-CoV-2 virus that your immune system responds to. If viral levels are low, they can potentially generate a false negative result because an individual may have not started showing symptoms yet. These rapid tests are not currently covered by health insurance, but a single rapid antigen test can be purchased for as low as $10.

PCR COVID Tests

Polymerase chain reaction (PCR) tests detect the genetic material of a virus by amplifying any existing genetical material that is within a sample. Because of this, these tests can detect even the smallest of viral loads, which leads to more accurate test results. An at-home PCR test can cost upwards of $100 because you must mail your sample into a lab.

Factors That Influence Whether a COVID-19 Test is Covered By Insurance

There are a few different factors that impact one’s ability to have an at-home COVID test covered by health insurance. Some of these factors include if whether or not the doctor ordered the test, and if you have additional funds through your employer or insurance plan.

Doctor Ordered Tests

If your doctor specifically recommends that you are in need of a COVID test based on your symptoms and if they give you permission to take an at-home test, then you can submit a claim to your health insurance. This is typically the only way to obtain an at-home COVID test that is covered by health insurance. If you go to a local pharmacy on your own, your insurance will not cover this at-home test.

FSA or HSA Funds

If you have a flexible spending account (FSA) or health savings account (HSA), it is possible to use the money in your account to buy an at-home COVID test. Essentially, this implies that you can use money that is pretax to purchase the tests. 

With an FSA, you typically have to use up the remaining money in your account by the end of each year. Thus, at-home COVID tests may be a solid purchase at the end of each year if you are concerned about being around various individuals around the holidays.

HSA funds however do not expire, thus you can roll them over each year. Although you do not need to use up all this money immediately, you can use the money available in your HSA at any point to buy at-home tests with the pretax money.

Finding Free At-Home COVID-19 Tests

There are some free at-home COVID-19 tests being provided based on where you reside. These at-home COVID-19 tests are similar to in-person COVID-19 tests that are available at clinics, medical offices, and other drive-through facilities. The only difference is that you will receive an at-home test kit that will enable you to collect your own sample. Rapid free at-home COVID-19 tests are available at the following locations:

• Matanuska- Susitna Borough, Alaska
• Maricopa County, Arizona
• Colorado
• Fulton County, Georgia
• Indianapolis Metro Area, Indiana
• Louisville Metro Area, Kentucky
• Sussex County, New Jersey
• Ohio
• Virginia
• Spokane County, Washington

The following states also provide free at-home PCR COVID tests:

• Delaware
• Idaho
• Iowa
• Massachusetts
• Minnesota
• Missouri
• New Hampshire
• Passaic County, New Jersey
• New Mexico
• North Carolina
• South Dakota
• Wisconsin
• Wyoming

Bottom Line

As the pandemic continues and new variants emerge, at-home COVID tests provide an edge that makes it easier and more convenient for individuals to get tested. Although insurance typically does not cover at-home COVID tests, there are still ways to minimize the overall cost of at-home COVID tests.

By signing up for Mira today, you can receive access to urgent care visits for as low as $25 on average per month. Mira is available for individual plans, whole families, and even employers. With Mira, you also gain access to lab testings and up to 80 percent off on over 1,000 prescriptions and even discounted gym memberships. Join and save, today!