Reimbursement for OTC COVID-19 at-home test kits

Reimbursement for OTC COVID-19 at-home test kits
January 12, 2022 Erica Manhardt
covid tests

At-Home COVID-19 Self-Test Coverage & FAQs for Members

As a Meritain Health member, per the Federal Government, you are eligible for insurance reimbursement under a qualified plan for FDA-authorized COVID-19 at-home tests purchased on or after January 15. Learn more about what’s covered and what you need to do to get reimbursed and get answers to other frequently asked questions about at-home COVID-19 self-test coverage.

New federal guidelines allow members with private or employer-sponsored commercial health insurance to request reimbursement for over-the-counter COVID-19 diagnostic tests that are purchased on or after January 15, 2022.

Be sure to check back regularly as information is evolving quickly.


What you need to know

Who is eligible?

If you have private or employer-sponsor health insurance you’re eligible to get reimbursed for over-the-counter at-home COVID kits.

Note: This new coverage reimbursement policy doesn’t apply to members who have Medicare, Medicare Supplement, Medicaid or voluntary insurance.

What's covered?

Based on the guidelines provided by the Biden administration, we will cover up to eight (8) over-the-counter (OTC) at-home COVID-19 tests per 30-day period for each person covered under your plan.

Note: Each test is counted separately even if multiple tests are sold in a single package. For example, a family of four covered under the same plan could be reimbursed for up to 32 tests per 30-day period.

Other things to keep in mind:

  • Tests must be approved, cleared or authorized by the U.S. Food and Drug Administration.  
  • You can only get reimbursed for tests purchased on January 15, 2022 or later.
  • These tests don’t require an order from your physician to qualify for reimbursement, although tests ordered by a provider aren’t subject to the frequency limit.
  • Tests must be used to diagnose a potential COVID-19 infection. Tests used for employment, school or recreational purposes are not eligible for reimbursement.

What are the steps to get reimbursed?

In most cases, OTC tests will be covered under your pharmacy benefits. Just check your benefits card to find your prescription benefits manager.

At this time, you’ll need to submit a request for reimbursement.


Where can I go to find at-home over-the-counter COVID-19 tests?

You can buy OTC COVID-19 tests at pharmacies, retail locations or online. Just keep in mind that the Omicron variant has created an overwhelming demand for OTC COVID-19 tests in many communities, so supplies may be limited.

To help improve access to these tests, the Biden-Harris Administration is expanding access to free, at-home kits through the federal government. More information on this program is expected soon.

Legal Notices

Meritain Health is a subsidiary of Aetna and CVS Health.

Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).

Health benefits and health insurance plans contain exclusions and limitations.

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