As of Saturday, private health insurers are required to cover the cost of at-home COVID-19 test kits — making them free, with no copay, for Mainers with private health insurance.
Mainers who receive health insurance through MaineCare can also get at-home tests paid for, although Medicare does not cover at-home tests at this time. But the process for most Mainers will not be as simple as walking into a pharmacy and walking out with free tests.
At the beginning, most will have to pay for tests upfront and then seek reimbursement from their insurance company. Here is what to know about getting your at-home tests paid for.
How many at-home COVID-19 tests will my insurance pay for?
Insurers are required to cover eight tests per person each month. The guidelines refer to the number of individual tests, not packs of tests. So if you are buying tests in packs of two, such as the BinaxNOW tests commonly sold in pharmacies, your insurer must cover only four.
Does it matter where I buy a test?
Insurers are required to cover the entire cost of a test if it is purchased at an in-network pharmacy. If it is purchased at an out-of-network pharmacy, your insurer must reimburse you up to $12 per test. You must pay the difference if it costs more.
If you are not sure whether a pharmacy is in-network, check with your insurer. If you have filled prescriptions at a pharmacy before, they may have your insurance information on file and can confirm whether they are in your network. If you are buying tests from an online retailer, you may want to do a bit of extra research to ensure the cost will be fully covered.
The Federal Trade Commission has also warned consumers to exercise caution when buying COVID-19 tests online, as some scammers have attempted to take advantage of the high demand for tests. While tests purchased directly from large retailers such as Walmart are a safe bet, use caution if you are not familiar with the retailer and avoid sites like eBay and Craigslist, where it can be hard to verify the seller.
What will I have to do to ensure my health insurance reimburses me?
Generally, you should plan to save your receipt from your test purchase to submit to your insurance company, which will then reimburse you. Also make a note of the test’s universal product code — the 12-digit number below the bar code — as some insurers may want that. The Bangor Daily News also asked Maine’s dominant health insurers about their plans.
Harvard Pilgrim will have a form available for members beginning Jan. 19 that can be used to claim reimbursement on tests purchased since Jan. 15. The insurer asks customers to save copies of their receipts that can be submitted to insurance.
Those insured through Maine Community Health Options will need to pay for tests at the time of purchase and then submit the receipt, along with a form and a copy of the test’s universal product code, to get reimbursed. The insurer is working on a way for members to buy tests without an upfront cost, but that is not yet available.
A spokesperson for Anthem said the insurer was receiving the requirements and would have more information available online as soon as possible. Aetna is advising members that they will need to submit receipts for reimbursement, and that information on how to do so will be available after Jan. 15.
People insured through MaineCare can use their MaineCare card to pay for at-home tests, with no out-of-pocket cost, at the pharmacy register. It will not cover tests if they are purchased at the main store register. Further guidance for MaineCare members is available here.
Will my insurance still cover testing in a hospital or lab?
Yes. Ordering at-home tests should not affect how your insurance covers other COVID-19 testing.
Where else can I get a test for free?
If you do not have health insurance, have already used all of your at-home COVID-19 tests or otherwise need a COVID-19 test, there are still sites where you can get tested for free.
Those include sites at the Bangor International Airport and Portland Jetport, a state-run testing site at the Augusta Armory and various pharmacy locations across the state. A list is here.
Beginning Jan. 19, people will also be able to order tests online for free from the federal government. You will only need to provide your name and home address, but tests will take between seven and 12 days to ship. Each residential address can receive up to four tests.
BDN writer Michael Shepherd contributed to this report.