Navigating COVID 19-related health care is challenging, particularly since the situation continues to evolve. When you find yourself in need of a COVID-19 test, that’s not the time when you want to decipher a flurry of complex information about who pays for it. Prepare yourself ahead of time so that you can avoid unpleasant surprises and focus on your health.

Will my health insurance cover the test?

The short answer is: it depends.

The Centers for Medicare & Medicaid Services (CMS) requires health insurers to fully cover COVID-19 testing by a legitimate health care professional “when medically appropriate for the individual, as determined by the individual’s attending health care provider in accordance with accepted standards of current medical practice.”

But what does that mean? Let’s explore a couple of scenarios to help you understand if you might be on the hook for out-of-pocket costs.¹

Scenario A – Jennifer has symptoms and may have been exposed

Jennifer wakes up with a temperature of 100.6, congestion and a mild cough. She received a notification a couple of days ago that someone she works with is ill with COVID-19. She decides to call her doctor’s office and is directed to come in for a test.

Scenario B – Jerry is not vaccinated and his employer requires COVID-19 testing

Jerry is not fully vaccinated, and his workplace requires proof of a negative COVID-19 test every week as a condition of employment. He has no symptoms of COVID-19 and is being tested for his employer’s requirement.

In the scenarios above, will Jennifer or Jerry need to pay out of their pocket for their tests?

In Jennifer’s case, she has symptoms and a known exposure. Jennifer’s test is considered “medically appropriate” and it will be covered by her insurance.

In Jerry’s case, he is being tested for general workplace health and safety. Federal law does not require health plans to provide coverage for testing for employment purposes.

In addition to testing for employment, federal law does not require coverage for testing for return to school or travel.

To sum it up, diagnostic testing (like to find out if Jennifer’s symptoms were caused by COVID-19) is covered, but back to work surveillance testing (like Jerry needed) is generally not covered.

How can I get tested?

There are now more options than ever for getting tested:

• Your doctor or local urgent care facility.
• Your pharmacy. Many pharmacies, such as CVS or Rite Aid offer testing.
• Your community health center. Find your local public testing center.
• At-home tests. You can purchase an instant or mail-in test at your pharmacy or online.

When in doubt about which test is right for you, your state’s information hub can be a great resource to help you decide.

Protect yourself from fraud while you protect yourself from COVID-19

Being vaccinated is still your best protection against becoming seriously ill with COVID-19, in addition to masking up and social distancing in high-transmission areas.

Information is your best protection against fraudsters who are out to play on your fears and prey on your wallet. If you do need a test, check with your doctor to make sure you’re receiving it from a reputable provider. Be wary of websites or stores selling products that claim to prevent, treat or cure COVID-19.

For example, products marketed for veterinary use, or “for research use only,” or otherwise not for human consumption, have not been evaluated for safety and should never be used by humans. They can cause adverse effects, including serious illness and death. Please do not believe news items or social media posts that advise taking veterinary medicines like ivermectin. The U.S. Food & Drug Administration (FDA) has issued a warning about this dangerous practice.

If you have a question about a treatment or test, talk to your doctor. If you have a question about a medication, call your pharmacist or the FDA hotline at 1-855-543-DRUG (3784). You can also email your question to druginfo@fda.hhs.gov.

¹ Testing policy as applicable for Commercial (employer group and Individual Health Coverage) plans.