This article was last updated on Jan. 19, 2022.
If you have COVID-19 symptoms, you’re going to want to get tested. Testing capabilities have expanded from what they were at the start of the pandemic and many health insurance plans now cover both testing from your health care provider, the local pharmacy and over-the-counter (OTC) COVID-19 tests.
The Biden Administration now requires all health insurance companies and group health plans to cover OTC tests with no member cost share External Site. This does not apply to Medicare Supplement members because Original Medicare does not cover OTC COVID-19 tests. However, free at-home tests are now available to anyone by request through the U.S. government External Site.
Testing for the coronavirus continues to be an essential tool in understanding the pandemic and the amount of COVID-19 that's in our communities. That's why it's important to understand the testing options available to you and how they're covered by health insurance.
Throughout the U.S., COVID-19 tests are available at no cost at health centers, select pharmacies and other established locations. The Families First Coronavirus Response Act External Site ensures testing is free to anyone in the U.S., including the uninsured. The Act remains in place as long as the country is in a public health emergency, as declared by the federal government. To find a COVID-19 testing location near you, visit The U.S. Department of Health and Human Services External Site. Each testing site can help you determine whether or not you should get a COVID-19 test, along with specific instructions on how to get tested.
Iowa’s program, called Test Iowa External Site, offers at-home test kits that you can return and receive your results via email. South Dakota has a similar public testing program External Site through the South Dakota Department of Public Health. These programs do not submit health insurance claims and are free of charge.
Health care provider testing
Hospitals, clinics, urgent care centers and other health care providers all have their own processes in place for COVID-19 testing. If you are experiencing a fever or acute respiratory symptoms (cough or shortness of breath), or have been in close contact with someone who has tested positive for COVID-19, call a health care provider before going to a doctor's office, clinic, urgent care or emergency department. During that call, your provider will assess your symptoms and direct you to the appropriate care.
Providers may have different procedures for handling COVID-19, so be sure to do some research online Opens New Window or call your doctor before going to your appointment. Also, check if your provider has a virtual visit option so you can see the doctor without leaving home. If you're a Wellmark Blue Cross and Blue Shield member, be sure to check your benefits in myWellmark® Secure to see if you have coverage for virtual visits.
If you have a COVID-19 test through your doctor or hospital, present your Wellmark ID card. The COVID-19 test will be processed through your insurance and covered in full.
“Many people are required to have a COVID-19 test before receiving a medical procedure or screening, such as a colonoscopy,” says Mike Fay, vice president of health networks and innovation at Wellmark Blue Cross and Blue Shield. “In this case, follow instructions provided by your health care provider. The testing will be billed to and paid for by your health insurance.”
Independent vendors or OTC tests
You may need to get the results of a COVID-19 test quickly. In this case, you may not have coronavirus symptoms, or you may be unable to schedule your test through a community testing site or through your doctor.
Wellmark will cover OTC COVID-19 tests through the end of the public health emergency, but there are some limitations.
OTC COVID-19 test guidelines for coverage
In order to be covered, the OTC COVID-19 test must be:
- Purchased on or after Jan. 15, 2022. Any OTC tests purchased before that date will not be reimbursed.
- Approved by or have an emergency use authorization from the Food and Drug Administration (FDA).
- A test that collects your own specimen and can be read at home. OTC COVID-19 tests that require you to drop off or mail your specimen to a laboratory are not covered under the OTC COVID-19 test coverage.
- Purchased from the counter of an in-network pharmacy and processed through the pharmacy system to receive direct coverage.
Members will only be reimbursed for up to eight OTC COVID-19 tests per member (including dependents on the same health plan) in a calendar month. As an example, if a family has five members on the same health plan, the family is eligible to be reimbursed for up to 40 OTC COVID-19 tests each calendar month. To find step-by-step instructions on how to submit a claim for reimbursement, visit Wellmark.com/Coronavirus Opens New Window.
Beware of untrustworthy sellers
COVID-19 tests administered by independent vendors generally aren’t covered by health insurance. "Insurance covers tests that are approved by the FDA and ordered by a heath care provider,” says Fay. “There are fraudulent tests and treatments out there. Be sure to do your homework first,” he warns.
Unfortunately, with high demand for OTC COVID-19 tests, there are quite a few tests being sold that have not been approved or authorized by the FDA. OTC COVID-19 tests purchased online are particularly vulnerable to potential fraud, so it’s important that you make sure you are buying OTC COVID-19 tests from valid and trustworthy pharmacies and sellers.
The Federal Trade Commission (FTC) has compiled some tips on identifying unauthorized tests and scams External Site when purchasing OTC COVID-19 tests online. Pharmacies and large national retailers are your best options to purchase a qualifying OTC COVID-19 test.
OTC COVID-19 tests currently approved or authorized by the FDA
The 13 OTC COVID-19 tests approved or authorized by the FDA. For the most up-to-date information, you can also refer to the FDA website External Site. Just be sure to enter "OTC" into the search box.
|Name||What the test looks like|
|CareStart™ COVID-19 Antigen Home Test||
|Celltrion DiaTrust™ COVID-19 Ag Home Test|
|iHealth® COVID-19 Antigen Rapid Test|
|QuickVue At-Home OTC COVID-19 Test|
|BD Veritor™ At-Home COVID-19 Test|
|Flowflex™ COVID-19 Antigen Home Test|
|SCoV-2 Ag Detect Rapid Self-Test|
|Ellume COVID-19 Home Test|
|BinaxNOW™ COVID-19 Antigen Self Test|
|CLINITEST® Rapid COVID-19 Antigen Self-Test|
|BinaxNOW™ COVID-19 Ag Card Home Test (comes in packs of 2, 3 and 6)|
|Roche COVID-19 At-Home Test|
|InteliSwab™ COVID-19 Rapid Test|
What is a COVID-19 test like?
Nasal swabs External Site and home test kits External Site are all more widely available External Site now, and new, faster testing methods may be on the way External Site. But for now, a test that detects COVID-19 is a direct, viral test that takes samples from the inside of your nose and/or throat to see if you are currently infected. Timing is key with the test and it can produce inaccurate results if you get tested at the wrong time.
It’s important to remember that no test for COVID-19 is 100 percent accurate, so you should follow prevention guidelines from the CDC External Site if you test positive, if you test negative, or if you haven’t taken a test at all.
For more information about COVID-19 testing, plus other benefit information related to COVID-19, visit Wellmark.com/Coronavirus Opens New Window. You can also check out our coronavirus tag here on Blue.
Some self-funded employer plans may differ in coverage or use a different pharmacy benefit manager (PBM). If your employer has a self-funded plan, please refer to your benefit documents/resources, your PBM or log in to myWellmark Secure if you have questions related to COVID-19 testing.