As of January 15, 2022, Massachusetts residents will be able to file claims for COVID test reimbursement. With a surge in cases again, at-home COVID tests have risen in popularity and have been hard to come by. They are also expensive, and many people may opt not to take them without reimbursement for COVID tests.
With concern for the safety of Americans, the Biden-Harris Administration is requiring commercial insurance providers to cover the cost of at-home COVID test kits. Since the program is still relatively new, insurance companies are scrambling to implement procedures to make the reimbursement process easy for their members.
The idea is that with reimbursement for COVID tests, Connecticut residents will be more likely to test themselves instead of putting it off. Safety and stopping the spread are the Biden-Harris administration’s top concerns, and there is also a website that free tests can be ordered on now delivered right to your door.
Massachusetts insurance providers have been on top of this new program. Since it was announced, they are working to get insurance reimbursements for COVID tests to their members as fast as possible. There are a lot of questions floating around with the launch of this program, so let’s look at some answers.
What Tests are Covered?
The program requires insurance companies to cover the cost of all FDA-approved at-home COVID test kits. Tests must be purchased from pharmacies and not third-party resale in order to be covered, as well. The only tests that are covered are ones that are for personal use. Any tests required for employment, or for travel will not be covered and claims could be denied if submitted.
Covered Brands:
- BinaxNOW
- QuickVue
- Inteliswab
- Lucira
How Many Tests Are Covered?
Through the program, individuals can receive up to 8 over-the-counter COVID test reimbursements per month. That means a family of four can receive up to 32 tests per household. Most of the tests on the market come in sets of two, and each test in the box will count as one of the 8 allowed a month. So, if you purchase a box of two tests, you can get reimbursement for 3 more that month. If you need additional tests, you will need to purchase them and pay out-of-pocket with no reimbursement.
Where Can I Buy At-Home COVID Tests in Massachusetts
Currently, at-home COVID tests kids are sold in retail stores and pharmacies. With the shortage in supply, they can also be ordered online and delivered to your home. The new program is strongly encouraging all insurance companies to create a preferred network of retailers that Connecticut residents can visit to obtain at-home COVID tests with no out-of-pocket cost.
Insurance Reimbursement for COVID Tests by Provider
Tufts Health Plan
Members of commercial Tufts Health Plans will receive reimbursement of COVID tests on the approved list provided on their website. Commercial, Direct and Group Medicare plan members can obtain at-home COVID tests at Caremark pharmacies at no out-of-pocket cost. This is currently the only pharmacy on the Tufts preferred network. If members purchase tests at other retailers, they can print out and mail in a claim form with receipts from purchase for COVID test reimbursement.
Tufts also specifically states that they will not pay for tests from third-party sources. So, if you purchase one from a resale option like Facebook Marketplace, you cannot get reimbursement.
As of February 1, 2022, Medicare Advantage members are also covered under this program. This only includes individuals receiving Medicare coverage through an employer. If you pay for your own Medicare plan, you are not covered under the program but are encouraged to order COVID test kits from the government website.
Tufts Health Plan Medicaid members can visit an in-network pharmacy and obtain approved tests at no out-of-pocket cost, including:
- BinaxNOW
- FlowFlex
- IHealth
- Inteliswab
- Quickvue At-Home
Harvard Pilgrim Healthcare
Harvard Pilgrim Healthcare Commercial plan members are covered under the new program. This insurance provider has implemented a preferred retail network for members to acquire at-home COVID test kits at no upfront cost. Plan members can visit a Walmart or Rite Aid pharmacy and receive a free COVID test kit without submitting a claim.
If plan members choose to purchase a test at a different retailer, they can print out and mail in a claim form along with their receipts. Claims can be made for COVID test reimbursement for all FDA-approved tests purchased on or after January 15.
Beginning February 15, 2022, Medicare Advantage members will also receive COVID test reimbursement through the program. Members will be able to receive at-home test kits with no out-of-pocket cost at in-network pharmacies, as well. Individuals with Medicare supplement plans are not currently covered and are directed to order tests from the government website.
BlueCross BlueShield
Massachusetts BCBS Commercial and Medicare Advantage members are covered for COVID test reimbursement. Members can download the claim form to submit online or mail it in for previous test purchases. The BCBS website directs members to save their receipts and documentation to submit with their claims. Without this, they may not receive COVID test reimbursement.
While other Massachusetts insurance providers have preferred retailers in place, BCBS is working on a national network. The network will have approved retailers that members can visit to obtain tests with no out-of-pocket costs. Members should continue to check the BCBS website for information and updates on this part of the program. Until it’s in effect, members will have to submit claims.
Group Insurance Commission
The Massachusetts Group Insurance Commission(GIC) provides healthcare for state workers. In an announcement on their website, they state that coverage will be provided through GIC’s pharmacy benefits manager, Express Scripts, and CVS Silverscripts for Medicare.
There is currently no claim form available for GIC members, but they are directed to hang on to their receipts for COVID test reimbursement. This means members will need to continue paying out-of-pocket for now. Members should continue to check with their plan for updates.
