Does health insurance cover the cost of the COVID-19 test?

In 2024, health insurance companies may not cover the full cost of a COVID-19 test. The Public Health Emergency (PHE) for COVID-19 ended on May 11, 2023. After that date, your insurance company and the plan you signed up for will likely determine your out-of-pocket cost for COVID-19 testing.

Why COVID-19 testing still matters

COVID-19 is now a seasonal virus that regularly circulates through communities. However, there is still a risk of severe illness in those who are immunocompromised or take immune-suppressing drugs and those with a weak heart or lungs. There is also a risk of post-COVID complications in individuals who otherwise experienced mild symptoms during the infection.

According to infectious disease specialists, it is still a good idea to test for COVID-19 when experiencing symptoms even if you are fully vaccinated and the symptoms are mild. The symptoms of runny nose, cough, and congestion with or without fever may resemble those of a mild cold in fully vaccinated individuals.

Benefits of getting tested

• Knowing they have COVID-19 may encourage patients to self-isolate and prevent spreading the infection.
• Knowing they have COVID-19 may encourage patients to take their sickness more seriously and get rest. Getting rest at home and utilizing at-home care methods can aid with a speedy recovery without complications.
• If complications develop, patients will be more aware that they may be COVID-related which can result in seeking prompt medical attention.
• Knowing the COVID-19 status can help guide travel plans and visits with elderly or immunocompromised family members and friends.

How to get tested for COVID-19 infection

Currently, there are two major options for getting tested for COVID-19 infection.

One option is to visit a testing site for an antigen-based or PCR-based COVID-19 infection test. Thousands of testing sites in the U.S. still perform COVID-19 infection tests at no cost or reduced cost to individuals.

The benefit of this approach is that it is economical and accessible to everybody. However, the drawback is that it involves traveling to the testing site when sick which can be exhausting when a person is already unwell, risks spreading the virus, and catching secondary infections during the trip. It can also be challenging to take sick children to a testing site.

The second option is to perform an at-home antigen test or at-home sample collection for a PCR test that will be done at a laboratory. Such tests, especially the PCR-based ones, offer the accuracy of lab testing in the comfort of one’s home. The tests can be stored at home for the future and performed at any time including during traveling. 

The disadvantage of at-home tests is that they rely on sample collection by patients and their families. If the sample is not collected properly, it may yield a false negative result (the person has COVID-19 but the test shows no infection). Alternatively, if the sample is accidentally contaminated, for example by the person administering the test for someone else, the test may yield a false positive result (the person being tested does not have COVID-19 but the test shows the presence of COVID-19 infection).

However, most people are comfortable following the directions of the sample collection kit, and as a result, at-home testing kits are extremely popular. During the COVID-19 public health emergency, over 870 million at-home COVID tests were distributed by the U.S. federal government through USPS directly to American households. After the end of the Public Health Emergency, the free kit distribution program ended on March 8, 2024. 

People must rely now on COVID-19 testing kits that they can purchase out-of-pocket with some costs possibly shared by insurance depending on their health plans. Individuals with a health savings account (HSA) or flexible spending account (FSA) can typically use these funds to purchase over-the-counter at-home tests.

The current state of coverage

Different insurance companies and insurance plans offer varying levels of test coverage. Patients should check their coverage status with their insurance providers. The following are the general guidelines from some of the large insurance providers. However, it is always recommended to check your plan’s benefits as COVID-19 test coverage can change over time.

Aetna. For most employer-sponsored and individual and family (ACA) plans, Aetna covers COVID-19 diagnostic tests with standard cost sharing according to the plan’s in- and out-of-network benefits. Based on the plan, the patient would need to pay to cover the deductible, copay, or coinsurance.

Medicare, Medicaid, or Children’s Health Insurance Program (CHIP). These plans cover COVID-19 testing to different extents. If a medical provider orders a lab-based COVID-19 PCR and antigen tests, those enrolled in Medicare Part B will continue to have coverage with no out-of-pocket costs. Those enrolled in a Medicare Advantage plan may have greater access to tests depending on their benefits. Medicaid and CHIP continue to fully cover COVID-19 over-the-counter and laboratory testing through September 30, 2024. After that date, testing coverage is expected to vary by state.

BlueCross BlueShield. Coverage of COVID-19 testing varies based on the insurance plan.

UnitedHealthcare. Most plans do not cover over-the-counter at-home COVID-19 tests. However, if a primary care physician orders a PCR-based test, part of the cost may be covered by insurance depending on the plan benefits.

Kaiser Permanente. The coverage of self-tests will depend on the plan benefits. Some plans allow ordering at-home COVID-19 tests from Kaiser Permanente at no cost and have them delivered at home by mail usually within a week.