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COVID-19 Testing

Who is eligible for over the counter at-home COVID-19 test kits?

Anyone can visit COVIDtests.gov to order four coronavirus test kits to be sent directly to your home, free of charge.

Commercial, Individual, Self-Funded
At this time, as a result of a federal directive, for all commercial, individual, and self-funded members, CDPHP will be reimbursing for kits purchased out of pocket (up to $12 per test or $24 for a kit containing two tests).

Medicare
Effective April 4, 2022, Medicare will cover up to eight over-the-counter COVID-19 tests each calendar month, at no cost to you.

Medicare will cover these tests if you have Part B, including those enrolled in a Medicare Advantage plan.

If you are in a Medicare Advantage plan, the tests covered under this initiative will be covered outside of your existing plan’s coverage, and in addition to any over-the-counter tests that may be covered under the plan as a supplemental benefit.

Medicare won’t cover over-the-counter COVID-19 tests if you only have Medicare Part A (Hospital Insurance) coverage, but you may be able to get free tests through other programs.

You can get over-the-counter COVID-19 tests at any pharmacy or health care provider that participates in this initiative.

Check with your pharmacy or health care provider to see if they are participating.

If so, they can provide your tests and will bill Medicare on your behalf.

A partial list of participating pharmacies can be found at https://www.medicare.gov/medicare-coronavirus.

You should bring your red, white, and blue Medicare card to get your free tests (even if you have a Medicare Advantage Plan or Medicare Part D plan), but the pharmacy may be able to get the information it needs to bill Medicare without the card.

Medicare coverage and payment begins on April 4, 2022, and is available for up to eight over-the-counter COVID-19 tests per calendar month you receive from a participating pharmacy or health care provider after the initiative starts.

Medicare will not provide payment for over-the-counter COVID-19 tests obtained prior to April 4, 2022.

Medicare cannot process a claim submitted by a beneficiary for a COVID-19 over-the-counter test.

Medicare will pay for up to eight free over-the-counter COVID-19 tests per calendar month through this initiative as long as the COVID-19 public health emergency continues. 

We will honor receipts for any purchases made on or after January 15 until April 18.

  • After April 18, you must go to a participating pharmacy to obtain test kits with your red, white, and blue Medicare card, or submit a physician order plus your receipt(s) to CDPHP.

  • To submit receipts, log in to your online member account or use this form.

Medicaid
Medicaid members may continue receiving one kit (with two tests) per week with a fiscal (prescription) order (no refills). The pharmacy will process the claim at no cost-share to you.

Child Health Plus
Child Health Plus members may receive two FDA-authorized COVID-19 test kits, per week, with no cost-sharing. Covered “at home” test kits must be authorized by the FDA for use in both symptomatic and asymptomatic patients and allow for self-collection without medical observation.

Essential Plan
Essential Plan members may receive two FDA-approved test kits per week. The pharmacy will process the claim at no cost-share to you. Test kits purchased on or after January 15, 2022, are eligible for reimbursement by visiting www.caremark.com or downloading the reimbursement form.

 
What is the best way for me to get an over the counter at-home COVID-19 test kit?

You have several options:

  • Visit COVIDtests.gov to order four coronavirus test kits to be sent directly to your home, free of charge.

  • For commercial, individual, and self-funded members, visit a participating CDPHP network pharmacy, select your test kits, and bring them to the pharmacy counter along with your CDPHP member ID to obtain them at no upfront cost. You can find participating pharmacies by visiting our Find-A-Doc website.

    • You may also place an order online at CVS.com or use the CVS Pharmacy app and click on “At-home COVID-19 tests”. CDPHP will cover the cost of this at-home COVID-19 test kit(s) up front. Enter your ZIP code and it will provide details on the closest store and product availability. If you want the tests delivered to your home, you can pay out-of-pocket and submit your receipt for reimbursement.

    • Purchase test kits on or after January 15, 2022, and submit receipts for reimbursement by visiting www.caremark.com or downloading the reimbursement form.

  • Effective April 4, 2022, Medicare will cover up to eight over-the-counter COVID-19 tests each calendar month, at no cost to you. You can get over-the-counter COVID-19 tests at any pharmacy or health care provider that participates in this initiative. You should bring your red, white, and blue Medicare card to get your free tests (even if you have a Medicare Advantage Plan or Medicare Part D plan), but the pharmacy may be able to get the information it needs to bill Medicare without the card.

  • Medicaid members may continue receiving one kit (with two tests) per week with a fiscal (prescription) order (no refills). The pharmacy will process the claim at no cost-share to you.

  • Child Health Plus members may receive two FDA-authorized COVID-19 test kits, per week, with no cost-sharing. Covered “at home” test kits must be authorized by the FDA for use in both symptomatic and asymptomatic patients and allow for self-collection without medical observation.

  • Essential Plan members may receive two FDA-approved test kits per week. The pharmacy will process the claim at no cost-share to you. Test kits purchased on or after January 15, 2022, are eligible for reimbursement by visiting www.caremark.com or downloading the reimbursement form.

  • Call CDPHP member services for assistance. If you are sick now, we can help direct you to get tested, or you can visit a local testing site.

What if my pharmacy benefit is not administered by Caremark through CDPHP?

Self-insured groups that have their pharmacy benefits carved out should talk with their employer; all other groups are covered under the medical benefit at the pharmacy.

 

What happens if I purchase (pay out of pocket) an over the counter at-home COVID-19 test kit at the front of the store checkout, at the pharmacy counter, a non-pharmacy retail store, or online vendor?

If you purchase test kits from another retailer (such as Amazon) on or after January 15, 2022, and your plan allows for reimbursement as indicated in the first question above, submit receipts for reimbursement by visiting www.caremark.com or downloading the reimbursement form.

Please note: Medicare cannot process a claim submitted by a beneficiary for a COVID-19 over-the-counter test.

 

Which over the counter at-home COVID-19 test kits are covered?

Please see the guidelines below for certain lines of business:

Commercial, Individual, and Self-Funded Plans

Label Name Manufacturer NDC/UPC Number of Tests per Package
Flowflex COVID-19 AG Hometest Acon 82607-0660-26 1
ON/GO COVID-19 Antigen Self-Test Access Bio 60006-0191-66 2
BinaxNOW COVID-19 AG Card Home Test Abbott 11877-0011-40 2
Inteliswab COVID-19 Rapid Test Orasure 08337-0001-58 2
Quickvue At-Home COVID-19 Test Quidel 14613-0339-72 2
Quickvue At-Home COVID-19 Test Quidel 14613-0339-68 5
FlowFlex COVID-19 Ag Home Test in Vitro Kit Acon 82607-0660-27 2
FlowFlex COVID-19 Ag Home Test in Vitro Kit Acon 82607-0660-28 5

 

Medicaid and Essential Plan

Test Name Reimbursement NDC
BinaxNow COVID-19 Antigen Self-Test Up to $24 11877-0011-40
QuickVue At-Home COVID-19 Test Up to $24 14613-0339-72
InteliSwab COVID-19 Rapid Test Up to $24 08337-0001-58
CareStart COVID-19 Antigen Home Test Up to $24 50010-0224-31
iHealth COVID-19 Antigen Home Test Up to $24 56362-0005-89
FlowFlex COVID-19 Antigen Home Test Up to $24 82607-0660-26
FlowFlex COVID-19 Antigen Home Test Up to $24 82607-0660-27

 

How long will it take to get my reimbursement?

Reimbursement can take up to 30 days.

 

Can I submit for a reimbursement for an over the counter at-home COVID-19 test kit that I purchased before January 15 without a prescription?

No, this federal directive is not retroactive.

 

What do I do if I test positive on my at-home COVID-19 test?
 
How do I get tested at a point-of-care site for COVID-19?

Please contact your provider, schedule a telemedicine visit, or visit The New York State Department of Health website to locate a testing site.

CDPHP will pay for COVID-19 testing (including rapid testing)* that has been determined to be medically appropriate by an attending provider or pharmacist, and when testing is approved by the FDA or issued an Emergency Use Authorization (EUA). 

Testing ordered or requested by someone other than an attending provider or pharmacist, or performed without an order, including testing on asymptomatic individuals as required by employers, schools, camps, sports, and epidemiological research, or for the purpose of travelling to and from New York state, is not covered.

*Some employers who self-insure do not have this benefit. If you are unsure if your plan includes this benefit, please contact CDPHP member services.

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