When are COVID-19 tests covered?
Blue Shield and Blue Shield Promise cover most diagnostic tests for individuals at no out-of-pocket cost to you. (See below for those not covered.) This means you do not need to pay out-of-pocket costs (copay, coinsurance, or deductible) for tests that are provided or ordered by a healthcare provider:
- Whether or not you have symptoms of COVID-19.
- Whether or not you think you were exposed to someone who has COVID-19.
Out-of-pocket testing costs for COVID-19 individual diagnostic tests will be waived during the federal public health emergency. This will continue as long as state and federal mandates for the coverage of testing without out-of-pocket costs apply.
For Medi-Cal members, all tests are fully covered at no cost to members. This applies both during and after the federal public health emergency.
Which types of COVID-19 diagnostics tests are covered?
Blue Shield and Blue Shield Promise cover these diagnostic tests:
- Standard PCR tests sent to a lab
- Rapid, point of care antigen tests (where results are available within a few minutes)
- Home test kits when ordered by a licensed healthcare provider
Tests must be provided or ordered by a healthcare provider licensed or authorized to provide or order COVID-19 tests.
When are COVID-19 tests not covered?
COVID-19 tests are not covered in these cases:
- When the test is not ordered or provided by a licensed or authorized healthcare provider. For example, if you pick up a home test kit online or from Costco, a grocery store, or a pharmacy.
- When the test is an antibody test, with some exceptions. In most cases, antibody tests are not suitable for diagnosing COVID-19. These types of tests will not tell you if you have an active infection or are still contagious.
- Screening as a prerequisite for entry into the US from international travel. See below for more details.
- For group testing required expressly for the reasons below unless ordered for each individual by an authorized healthcare provider. If an authorized healthcare provider does not order the test, the member, employer, school, or government will need to cover the full cost.
- Screening for employment or return to work.
- Screening for return to school or sports for students or staff.
- Public health surveillance.
When will I have to pay a copay for a COVID-19 test?
No copay or out-of-pocket costs will apply for individual diagnostic testing provided or ordered by a healthcare provider that meets the requirements above.
Can I go anywhere to get a test?
Blue Shield recommends that you get tested at a network location when possible. However, diagnostic testing ordered or performed by licensed or authorized out-of-network health care providers is also covered.
Make sure that the location you are getting tested at offers diagnostic tests rather than antibody tests. For example, some labs only collect blood samples for antibody tests. See Where can I get a test? to find locations.
Can I get a home COVID-19 test kit from Blue Shield?
Blue Shield will cover home tests when ordered by a healthcare provider. Home test kits that a healthcare provider does not order will not be covered. See Where can I get a test? to find other testing locations.
If I need to get tested for travel, is that covered?
If a test is ordered or provided by an authorized healthcare provider, it will be covered.
If the test is conducted without a healthcare provider order or at a testing site that is not authorized or licensed to order COVID-19 testing, then you will have to pay for the full cost of the test.
Coverage for COVID-19 testing internationally is dependent on your plan benefits and the reason for testing. For some plans, only emergency and urgent care are covered internationally, and COVID-19 testing for routine travel does not qualify as urgent or emergency care. However, if you fall ill with COVID-19 like symptoms while traveling, testing and treatment may be covered if appropriate documentation is submitted. Please check your Evidence of Coverage or plan policy documents to find out what is covered when traveling internationally.
COVID-19 requirements vary worldwide. We highly recommend you review the host country’s COVID-19 requirements before you travel to or within that country.
Can I go to a temporary or pop-up COVID-19 testing site?
Yes. COVID-19 testing at temporary or pop-up testing sites is covered by Blue Shield and Blue Shield Promise without out-of-pocket costs.
You will need an appointment for most of these sites. You may also have to fill out a screening form. They do not have a lot of openings for unscheduled visits (walk or drive-in). This may result in very long wait times.
If I paid out-of-pocket for a COVID-19 test that should be covered, what do I need to do?
Call Customer Service at the number on your member ID card. Customer Service will help you submit your claim if your provider has not submitted it.
You will need to show either the provider’s order or proof of your referral for your COVID-19 diagnostic test for your claim to be processed by Blue Shield.
Have more questions about coverage?
Call the phone number on your Blue Shield or Blue Shield Promise member ID card.