When are COVID-19 tests covered?
As of February 26, 2021, 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 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.
The only exception is home testing for essential workers. If you are an essential worker, you may have to pay a copay, coinsurance, or deductible depending on your plan benefits. For more details, see When will I have to pay a copay for a COVID-19 test?.
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)
Tests must be provided or ordered by a healthcare provider licensed or authorized to provide or order COVID-19 tests.
Home test kits for essential workers are also covered, but only if ordered through the Blue Shield order site. However, out-of-pocket costs may apply.
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.
- For group testing required for the following reasons:
Screening for employment or return to work.
Screening for return to school or sports for students or staff.
Public health surveillance.
This means that the member, employer, school, or government will need to cover the full cost of the test when group testing is done expressly for the reasons listed above.
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.
The only test that requires out-of-pocket costs is the at-home test kit for essential workers that is ordered through Blue Shield’s Pixel by LabCorp order page. Please check your Evidence of Coverage or plan policy documents to find out which COVID-19 tests fall under your plan’s laboratory services benefit and what your out-of-pocket costs would be.
I’m an essential worker. What options do I have for testing?
If you are an essential worker as defined by the Department of Managed Health Care, you have the same testing options as all members. Blue Shield also provides essential workers an option to order an at-home test kit without a provider visit. Standard copays, deductibles, and coinsurance will apply based on your in-network benefits. This option is available only through Blue Shield’s Pixel by LabCorp order page. Home test kits ordered from other sites without a health care provider order are not covered.
Please check your Evidence of Coverage or plan policy documents to find out what your out-of-pocket costs would be for home test kits ordered through the Blue Shield member portal, as well as which other COVID-19 tests fall under your plan’s laboratory services benefit.
Blue Shield does not provide coverage for group testing for employment purposes. In this case, you may be responsible for the full cost of the test unless it is being paid for by someone else (such as your employer or the government).
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?
Only members who are essential workers and meet the criteria below can order a home test kit through Blue Shield’s Pixel by LabCorp order site:
If both of the above are true, then you can order a home testing kit. It must be ordered through Blue Shield’s Pixel by LabCorp order page to ensure coverage. However, standard out-of-pocket costs will apply.
If you are an essential worker and order a home test kit from anywhere else, you will be responsible for the full cost of the test. This includes if you order directly from Pixel/ LabCorp using their general test kit webpage, or purchase a home test kit from any other online lab, grocery store, or pharmacy, etc.
For all other members, home test kits are not a covered benefit unless they are ordered by a healthcare provider.
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.