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Home COVID-19 Tests and Reimbursements

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In the wake of the Omicron COVID-19 surge, politicians and health care leaders have been scrambling to get rapid at-home COVID-19 tests out to everyone. You may have heard that COVID-19 tests now can be accessed for free—but this evolving policy does come with some caveats. If you have private health insurance, you now can be reimbursed for a certain number of COVID-19 tests each month, but you may have to go through a reimbursement process, and this development does not apply to those with Medicare who purchase an over-the-counter test. 

It can be confusing to sort through the news stories about reimbursement and COVID-19 testing. Here is a simple breakdown of everything you need to know about insurance coverage of home COVID-19 tests, testing types, and what to do if you test positive or negative for COVID-19. 

Why Are Some COVID-19 Tests Free Now? 

On January 10, the Biden administration announced that it would begin requiring private insurance carriers to cover at-home tests to screen for the presence of the SARS-CoV-2virus that causes COVID-19 disease. This initiative is part of a wider effort to expand testing, especially as the U.S. Centers for Disease Control and Prevention (CDC) has updated its recommendations to include COVID-19 testing at five days after a known exposure, if possible. 

How Many Tests Are Covered by Insurance? 

According to the announcement, insurers will be required to provide reimbursement for eight COVID-19 tests per individual per month, starting January 25, 2022. This applies to rapid tests that have been purchased over the counter, not those that a medical provider has ordered. Depending on your insurance, you may be able to pick up these tests at a pharmacy without going through a reimbursement process—or you may need to save your receipt and submit a claim. 

If you have Medicare, this policy does not apply to purchases of over-the-counter tests. However, the Centers for Medicare and Medicaid Services (CMS) notes that it has authorized 50 million at-home tests to be distributed to Medicare-certified health centers and community health clinics. 

What Kinds of Tests Are Now Covered by Insurance? 

Tests must have U.S. Food and Drug Administration (FDA) approval to be covered. The covered tests are rapid at-home kits, which are performed entirely at home and yield a result within minutes—they do not need to be mailed to a lab for analysis. These tests are classified as antigen tests, which are different from the polymerase chain reaction (PCR) tests that you may be familiar with. 

When Should I Take an At-Home COVID-19 Test? 

The Biden administration is augmenting the accessibility of at-home tests to Americans because there is an increased demand for testing during the current Omicron surge. 

You may need to take an at-home COVID-19 test if: 

  • You have symptoms of COVID-19 illness such as congestion or runny nose, loss of taste or smell, sore throat, fever, body aches, or cough. 
  • You’ve been in contact with someone who is known to have COVID-19. 
  • You’re planning to attend a large group gathering at which there may be vulnerable adults present. 

Additionally, many Americans have recently been asked to provide evidence of a negative COVID-19 test result to participate in an event or to return to work after a period of illness. 

How Does an At-Home COVID-19 Test Work? 

A rapid antigen test can detect the presence of viral particles, which indicates that you have a current COVID-19 infection and are capable of spreading it to others. This can be a helpful assessment from a public health standpoint because you can document that you either do or do not have a contagious illness directly before engaging in a given activity. A negative rapid test can also be a helpful way to end your period of isolation after initially testing positive. 

What Is the Difference Between Rapid Tests and PCR Tests? 

Although a rapid antigen test can detect potential COVID-19 disease, it is not as accurate at detecting COVID-19 as a PCR test, which is considered to be the gold standard. A PCR test amplifies very small amounts of viral DNA, meaning that you can test positive for COVID-19 even if there is just a tiny amount of virus in your sample. People may continue to test positive for COVID-19 via PCR testing for weeks after the virus, which is why it is not a useful test for point-of-care or “return to work” purposes. 

What To Do When You Receive the Results of an At-Home COVID-19 Test 

Once you have followed the steps of COVID-19 testing, it is important to know what to do with the information that follows. 

  • If you have a positive result, it means that the SARS-CoV-2 virus that causes COVID-19 was detected. You’re classified as being “positive for COVID-19” and capable of spreading it to others. According to the CDC, you should isolate for five days, and wear a mask for an additional five days. 
  • If you have a negative result but had a known positive exposure, the CDC recommends that you still quarantine for five days, and continue to wear a mask for 10 days. 

After At-Home Testing 

Once you have determined your COVID-19 status and mapped out a plan for isolation, if needed, the grand majority of your work is done. You should rest, hydrate, and keep an eye on your symptoms. Usually, people with COVID-19 illness, particularly the omicron variant, begin to improve within a few days after the onset of their symptoms. 

However, if you begin to have other symptoms—or if your illness seems to be worsening—it’s important to seek a formal test at a testing clinic or urgent care site. Additionally, if you have a negative test result but still think you may have COVID-19, it’s important to do a follow-up test after a few days or get a confirmatory PCR test to better characterize your situation. 

Research and materials for this article were compiled, written, and distributed on behalf of the National Public Health Information Coalition. The views and opinions expressed in this blog are those of the various authors and do not necessarily reflect the official policy or position of the National Public Health Information Coalition or its members. 

References: 

[1] Biden-Harris Administration Requires Insurance Companies and Group Health Plans to Cover the Cost of At-Home COVID-19 Tests, Increasing Access to Free Tests. https://www.hhs.gov/about/news/2022/01/10/biden-harris-administration-requires-insurance-companies-group-health-plans-to-cover-cost-at-home-covid-19-tests-increasing-access-free-tests.html#:~:text=As%20part%20of%20its%20ongoing,get%20them%20for%20free%20starting 

[2] CDC Updates and Shortens Recommended Isolation and Quarantine Period for General Population. https://www.cdc.gov/media/releases/2021/s1227-isolation-quarantine-guidance.html 

[3] How to get your At-Home Over-The-Counter COVID-19 Test for Free. https://www.cms.gov/how-to-get-your-at-home-OTC-COVID-19-test-for-free 

[4] Tests for current infection. https://www.cdc.gov/coronavirus/2019-ncov/testing/diagnostic-testing.html 

[5] Interim Guidance for Antigen Testing for SARS-CoV-2. https://www.cdc.gov/coronavirus/2019-ncov/lab/resources/antigen-tests-guidelines.html 

[6] CDC Updates and Shortens Recommended Isolation and Quarantine Period for General Population. https://www.cdc.gov/media/releases/2021/s1227-isolation-quarantine-guidance.html 

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