DETROIT – Many people don’t know that they are now entitled to receive eight free COVID tests per month.
If you’ve already ordered both sets of your four free COVID tests from the United States Postal Service, then you’re ahead of many people. While they’re free, they are limited to a total of eight tests per mailing address, and by now, there’s a chance you’ve already used them up.
Fortunately, there is another way to get more free tests.
On Jan. 15, the Biden Administration required all insurances to cover the cost of eight COVID tests per person per month, up to a cost of $12 per test. If the test cost is less than $12, you will have the cost covered.
Knowing this, I bought six tests about a week later and submitted the receipt to my insurance for reimbursement. But my claim was rejected. After I contacted them, it became apparent that it was a mistake on their part, related to the newness of the coverage.
But during the process, I also found a much simpler way to obtain the tests. Here are some simple things to know that can help you get the most out of this great benefit:
First, you are allowed to buy the tests any way you want -- online or at a brick and mortar store. But according to Natalie Pirkola, vice president of pharmacy services at Health Alliance Plan (HAP), internet purchases can pose a challenge because it’s often difficult for consumers to tell if they are buying tests oriented to consumers or bulk purchases for a larger organization.
It can also be difficult to tell online if tests are fully FDA authorized, which they must be in order to qualify for coverage.
“Purchasing through a retailer is a little bit more straightforward,” Pirkola said.
Getting reimbursed for tests
Wherever you purchase tests, if you buy them yourself, you will have to pay for them with your money first and then submit forms to your insurance for reimbursement.
“Each health plan is going to have a page either online or a paper to print out where they would be able to submit what’s called a ‘direct member reimbursement,’” Pirkola said.
She also recommended saving both the receipt from the purchase and the original box that tests come in. Insurance companies will often want the UPC code from the box to ensure it qualifies. Once you submit the necessary information, your insurance will send you a reimbursement check. That’s the route I went, and it did ultimately work out, but I did have to appeal their initial incorrect rejection.
Ordering at pharmacy counter
A much simpler way to get the eight tests per member per month is to simply go to an actual pharmacy counter in the back and ask the pharmacy staff to run the “purchase” as if you were filling a prescription.
“In the back, where there is the pharmacist, they actually have the ability to bill the insurance plan (directly),” Pirkola said. “Most importantly, it allows it to process at a -- I’ll call it a copay, of zero dollars. That allows you not to have to pay anything out of pocket, and that’s standard across not just the commercial insurance, but Michigan Medicaid, and as well as the new benefit with Medicare all allow for zero dollars.”
Let me make that completely clear: If you “buy” the tests at the pharmacy counter, not up front at the retail cashier, they will check it against your insurance coverage, and you will get them free, without laying out any cash.
This is for eight tests per person per month, not eight boxes. The point here is that some boxes contain two tests. In that case, you only get four boxes to total eight tests.
But here’s the biggest benefit: It’s eight tests per person per month, not per household. So if you are a family of four, you can get 32 free tests per month. The benefit renews every month -- unfortunately the definition of a month can vary by insurer. Some use 30 days, some use a calendar month. That’s part of the reason having the pharmacy submit the claim is helpful. They can tell if your cycle has refreshed for the “month.”
Testing process at pharmacy counter
We wanted to see how well it works to use the pharmacy counter to get your tests, so we sent in two producers with hidden cameras.
Our first producer was able to easily get four tests with no out-of-pocket payment. The only inconvenience was a 30-minute wait while the insurance claim was processed. When he went back to a different pharmacy, he had difficulty getting his remaining four tests because the original pharmacy submitted the claim for eight tests instead of four.
Without going back to the original pharmacy to correct the error, he was no longer eligible for another 30 days.
“You can actually get all eight in one transaction, so there isn’t a limit on how many per day,” Pirkola said. “It’s really just a limit in that one month or 30-day period.”
That’s what our first producer should have done.
Our second producer ran into similar problems and was only dispensed half of the tests she should have been able to get. But when she went to a second pharmacy, she was able to get the remaining tests for her, her husband and their daughter. That took 45 minutes to process.
Based on our experience, if you are getting tests from the pharmacy, I have a few recommendations. First, you should go to the back pharmacy first to get the process going while you continue your shopping, then plan to return after 30-45 minutes when the claim should be processed.
Second, get all eight tests at once for every person you are getting them for. If the pharmacy staff is unclear on the allowance, just be clear that it is eight tests per family member, per month.
Finally, make sure you have your insurance information with you and, if possible, go to a pharmacy that already has all your information in their system. It will save you time.
Even if you don’t need the tests right now, since we don’t know if insurance will continue to cover the cost beyond July 15, it’s a good idea to stock up while they’re free and have some tests on hand in case you need them in the future.
If you’re getting tests for future use, you should look for ones on the shelf that will expire later. The FDA has extended the expiration date printed on the box for many tests because the manufacturers are finding that their shelf life is longer than originally expected.