Table of contents

Coverage information for general COVID-19 testing

Are COVID-19 tests covered?

Yes, but coverage for testing varies by plan. Blue Shield and Blue Shield Promise will cover most COVID-19 tests at no out-of-pocket cost to you for specified plans noted below. This applies to both diagnostic and screening tests.

When are COVID-19 tests covered?

Blue Shield and Blue Shield Promise cover these types of tests:

Reasons to be tested
 
Diagnostic
Diagnostic & Screening
Screening
  Individual testing with or without symptoms Tests ordered by healthcare providers1 Tests for contact-tracing, known or suspected exposure Tests for employment, return to school, or sports2 Tests before or after travel
Individual and Family plans
Small business plans
Medi-Cal plans
Medicare Supplement plans
Cal MediConnect plans
Fully-insured or flex-funded group plans3
Yes Yes Yes Yes Yes
Medicare Advantage plans Yes Yes Yes No Yes
Self-funded group plans4 Yes Yes Yes Maybe5 Yes
Medicare Prescription Drug Plan6 (pharmacy benefit only) No No No No No

1Tests ordered by a healthcare provider means that a licensed and authorized healthcare provider has requested that you obtain a test for COVID-19. For example, a physician, a nurse practitioner, or a physician assistant. These tests can be for diagnostic or screening purposes, such as a screening before a procedure.

2Tests obtained for employment purposes, return to school, or sports are those requested at the direction of an employer, school, or sports league/facility or are for group testing rather than for individual assessment.

3If you receive your health insurance through your employer, association, trust, etc., please contact your employer, plan sponsor, or benefits administrator to see whether you have a fully-insured or a flex-funded group plan. You may also call the customer service phone number on your member ID card.

4These can be group plans from employers, associations, trusts, etc. If you receive your health insurance through your employer, plan sponsor, or benefits administrator, review your Blue Shield member ID card for the letters “ASO” (Administrative Services Only) to learn if you are on a self-funded or self-insured plan. Otherwise, contact your employer, plan sponsor, or benefits administrator. You may also call the customer service phone number on your member ID card.

5Self-funded group plans are not required to cover these costs. Some may choose to cover screening tests for employment purposes, return to school, or sports. Please refer to your specific benefits or contact your employer, plan sponsor, or benefits administrator for more information.

6Neither diagnostic nor screening testing is covered through pharmacy benefits. Therefore, Medicare PDP plans do not cover medical testing. Please check your Original Medicare or Medicare Supplement plan for testing coverage under your medical benefits. Learn how to get free OTC at-home tests through the federal program.
 

Which types of COVID-19 tests are covered?

Blue Shield and Blue Shield Promise cover these types of tests:

Types of tests covered
  Over-the-counter (OTC) at-home tests7 Standard PCR8 Rapid, point-of care antigen tests Antibody tests
Individual and Family plans
Small business plans
Cal MediConnect plans11
Medicare Supplement plans
Fully-insured or flex-funded group plans
YES for purchases on or after 1/1/22 Yes Yes Yes, when ordered by a provider9
Out-of-pocket costs may apply
Medicare Advantage Plans11 Yes when ordered by a provider9˒10 Yes Yes
Medi-Cal plans No
This is only covered through Medi-Cal Rx11
Yes Yes
Self-funded group plans Yes for OTC at-home tests purchased on or after 1/15/22 Yes Yes
Medicare Prescription Drug Plan (pharmacy benefit only) No, coverage for OTC at-home tests is covered by Original Medicare11 No No No
Medicare Supplement plans Yes, for purchases between 1/1/22 – 4/3/22
No, for purchases on or after 4/4/22
Coverage for OTC at-home tests is covered by Original Medicare11
Yes Yes Yes, when ordered by a provider9
Out-of-pocket costs may apply

7OTC at-home tests are only covered if used for personal use and not for resale. Also, there are some limitations to the number of tests that can be reimbursed without a provider order. See OTC at-home test section for more details.

8PCR tests (polymerase chain reaction) tests which are generally sent to a lab, but may also include rapid tests such as Nucleic Acid Amplification Tests (NAAT). Learn more about the different types of tests.

9 Tests ordered by a healthcare provider means that a licensed and authorized healthcare provider has requested that you obtain a test for COVID-19. For example, a physician, a nurse practitioner, or a physician assistant. These tests can be for diagnostic or screening purposes, such as a screening before a procedure.

10In the coming weeks, we expect more guidance from the Centers for Medicare & Medicaid Services (CMS) about coverage of OTC COVID-19 at-home tests for our members. Please check back here for the latest information.

11Medicare members can get up to eight OTC COVID-19 home tests each calendar month through the Centers for Medicare and Medicaid Services.
 

When will I have to pay for a COVID-19 test?

Most COVID-19 tests are covered with no out-of-pocket costs. Note that if you visit an out-of-network provider, your test may be covered. However, you may have out-of-pocket costs for other fees unrelated to the test. Learn more about potential out-of-pocket costs from out-of-network providers.

To avoid paying any out-of-pocket fees, choose a network testing location near you.

Out-of-pocket costs for COVID-19 testing: in-network vs. out-of-network
  In-network costs Out-of-network costs
Individual & family plans
Small business plans
Cal MediConnect plans
Medicare Supplement plans
Fully-insured or flex-funded group plans
None for covered tests None for covered tests during the public health emergency12˒ 13
Medicare Advantage plans None for covered tests None for covered tests during the public health emergency12˒ 13
Medi-Cal plans None
Self-funded group plans None for covered tests None for covered tests during the public health emergency12˒ 13˒ 14

12When the public health emergency ends, all out-of-network costs not paid by Blue Shield will be your responsibility.

13Other fees unrelated to the administration of the COVID-19 test may be charged for your visit. These may include fees for the appointment or other tests. The member will be responsible for any unrelated fees charged by an out-of-network provider. Learn more about potential out-of-pocket costs from out-of-network providers.

14For self-funded plans that choose not to cover fees related to the administration of COVID-19 tests, those costs will be the responsibility of the member. Related fees may include specimen collection or processing fees. Learn more about potential out-of-pocket costs from out-of-network providers.
 

If I need to get tested for travel, is that covered?

Domestic travel

Screening tests for domestic travel are covered for most plans. See which plans cover screening tests for travel.

International travel

Coverage for COVID-19 testing outside of the United States depends on your plan benefits and the reason for testing. For some plans, only emergency and urgent care are covered outside of the United States. COVID-19 testing for routine travel does not qualify as urgent or emergency care. However, if you fall ill with COVID-19 symptoms while traveling internationally, testing and treatment may be covered. Proper documentation will need to be submitted.

Please check your Evidence of Coverage or plan policy documents to find out what is covered when traveling internationally. Please remember that COVID-19 testing and vaccination requirements vary worldwide. We highly recommend you review the host country’s COVID-19 requirements before you travel.
 

Where to get tested

Where can I go to get a COVID-19 test?

You have a few options for where to get a test:

  1. Use our find a doctor tool to find an urgent care clinic if you have symptoms.
  2. Use the state testing locator to find a testing site. The location results from the State may include out-of-network sites.
  3. Check your county or local public health department.
  4. Find a health center that provides COVID-19 testing.
  5. There may be community testing sites available to help you.
  6. Visit an in-network testing location, like one of these retail pharmacies:

In addition to the locations listed above, there may be community testing sites in your area. You can also call the COVID-19 state hotline at (833) 422-4255 to find a test site near you.

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 with no out out-of-pocket costs. Just keep in mind some of these sites may be out-of-network. This means they may charge additional fees. Learn more about potential out-of-pocket costs from out-of-network providers.

For a quicker experience, you should make an appointment for most of these sites. You may also have to fill out a screening form.
 

Over-the-counter (OTC) at-home test

What are over-the-counter (OTC) COVID-19 at-home tests?

These OTC at-home tests are rapid results tests. The sample is taken at home and you can read the results in a few minutes. Everything is done at home. Nothing is sent to a lab. Coverage and reimbursement for OTC at-home tests is limited to those tests authorized for emergency use by the FDA. Find out how to tell if a test is authorized for emergency use by the FDA.

How can I get a free OTC COVID-19 at-home test?

The federal government is currently providing four free OTC COVID-19 at-home tests per household. Visit covidtests.gov for details or call (800) 232-0233.

Members with Medicare plans, see below

Medi-Cal members, see below.

Will I have to pay for an OTC at-home test?

No, the federal government is currently providing four free OTC COVID-19 at-home tests per household. Visit covidtests.gov for details or call (800) 232-0233.

If you purchase an OTC at-home test at a local retail pharmacy, store, or online, you can submit a claim to Blue Shield for reimbursement for the full cost of the test. See for how to submit a claim for these types of tests.

Members with Medicare plans, see below

Medi-Cal members, see below.

I have a Medicare plan. How can I get a free OTC COVID-19 test?

As of April 4, 2022, the Centers for Medicare & Medicaid Services (CMS) is covering up to eight free OTC COVID-19 at-home tests each calendar month at participating pharmacies and healthcare providers. This benefit is available to Blue Shield and Blue Shield Promise members in the following plans:

  • Medicare Advantage
  • Cal MediConnect
  • Medicare Supplement
  • Medicare Prescription Drug Plan (PDP) if you also have Medicare Part B coverage

See a list of participating pharmacies.

You should bring your red, white, and blue Medicare card to get your free over-the-counter COVID-19 tests. This applies even if you have another card for your Blue Shield or Blue Shield Promise plan.

I have a Medi-Cal plan. How can I get a free OTC COVID-19 test?

As of February 1, 2022, please contact Medi-Cal Rx to locate an in-network pharmacy. You will be able to obtain an at-home test at no cost through these network pharmacies.

If you purchased an at-home test previously, you may be able to get paid back. If you purchased an OTC at-home test between March 11, 2021, and January 31, 2022, the Department of Health Care Services (DHCS) will reimburse beneficiaries the retail cost with a receipt. See details on the State Medi-Cal website for how to submit a claim.

What are the limits to reimbursement for OTC COVID-19 at-home tests?

Blue Shield provides coverage for OTC COVID-19 at-home tests purchased prior to January 1, 2022, with a healthcare provider order.

As of January 1, 2022, most members can get reimbursed for up to eight OTC at-home tests per member per month without a provider order. Some restrictions apply. For example:

  • OTC at-home tests must have been purchased on or after January 1, 2022.
  • OTC at-home tests purchased from a private reseller, online auction, or resale marketplace like eBay are not covered.
  • OTC at-home tests that are reimbursed by other entities like a flexible spending account (FSA), health savings account (HSA) or health reimbursement account (HRA) or through reselling are not covered.
  • If you have a self-funded group plan, OTC at-home tests are not covered or reimbursable if purchased prior to January 15, 2022, without a healthcare provider order, or purchased at any time for employment purposes.
  • •If you have a Medicare Advantage Plan, you must have a healthcare provider order for your OTC at-home test purchases to be reimbursed by Blue Shield. For more options to get free OTC tests, see details above.
  • If you have a Medi-Cal plan, your at-home tests will be covered by your pharmacy benefits. See details above to learn more.

Find out what your coverage is for OTC at-home tests.

My at-home test kit comes with more than one test per package. Can I get reimbursed for multiple packages?

Each individual test within a package counts as one test. For example, if you purchase a package with two tests inside, that counts as two separate tests. In that case, you would be able to submit reimbursement for up to four packages, or eight tests total, for each member on your plan.

How can I tell if the OTC at-home test kit is authorized by the Food and Drug Administration (FDA)?

On the test kit package, look for a message that states the test has been authorized for emergency use by the FDA. Some examples of authorized tests include:

  • BinaxNOW COVID-19 Antigen Self-Test (Abbott)
  • BD Veritor At-Home COVID-19 Test (Becton Dickinson)
  • CareStart COVID-19 Antigen Home Test (Access Bio)
  • Celltrion DiaTrust COVID-19 Ag Home-Test (Celltrion)
  • CLINITEST Rapid COVID-19 Antigen Self-Test (Siemens)
  • COVID-19 At-Home Test (SD Biosensor)
  • Ellume COVID-19 Home Test (Ellume)
  • Flowflex COVID-19 Antigen Home Test (ACON)
  • iHealth COVID-19 Antigen Rapid Test (iHealth Labs)
  • InteliSwab COVID-19 Rapid Test (OraSure)
  • QuickVue At-Home OTC COVID-19 Test (Quidel)
  • SCoV-2 Ag Detect Rapid Self-Test (InBios)

See a complete list of authorized tests on the FDA's web page. Type “OTC” or “Home” in the search bar to narrow the results for at-home tests.

Are at-home COVID-19 test kits eligible items for reimbursement under an FSA, HSA, or HRA?

Yes, you can use your HSA, FSA, or HRA funds to purchase at-home test kits.

However, at-home COVID-19 test kits are not qualified medical expenses when the costs are reimbursed by Blue Shield.

Please note that Blue Shield does not offer tax advice for HSAs. HSAs are offered through financial institutions. For more information about HSAs, eligibility, and the law’s current provisions, you should ask you financial or tax adviser, or check with your HSA administrator for more details.

How am I reimbursed for at-home test kits if I use FSA, HSA, or HRA funds?

You should follow existing claims reimbursement processes to obtain an at-home test kit reimbursement.

Please note: You cannot be reimbursed more than once for OTC at-home test kits. If you intend to seek reimbursement from Blue Shield, it is recommended that you do not use an FSA, HSA, or HRA debit card to purchase at-home test kits.

Similarly, for at-home test kits paid for or reimbursed by Blue Shield, you should not seek reimbursement from an FSA, HSA, or HRA for the cost (or the portion of the cost). As such, Blue Shield does not deposit any reimbursements directly into an FSA, HSA, or HRA.

If you mistakenly receive reimbursement from an FSA, HSA, or HRA for at-home test costs covered by Blue Shield, you should contact the FSA, HSA, or HRA administrator. They can advise you on how to return the money back into your account.

Please note that Blue Shield does not offer tax advice for HSAs. HSAs are offered through financial institutions. For more information about HSAs, eligibility, and the law’s current provisions, you should ask your financial or tax adviser, or check with your HSA administrator for more details.

Claims submission and reimbursement for all COVID-19 testing

How can I submit a claim form for my OTC COVID-19 at-home tests?

For eligible plans, you can fill out a paper claim form and mail it in. You may also submit a digital claim online with a copy of your receipt.

Using a paper claim form allows you to submit reimbursement for multiple purchases and for multiple members at the same time.

If you use the online form, you must file a separate digital claim for each member and for each receipt.

You will only be reimbursed for the maximum allowable tests per member per month for your plan.

See details for how to submit a claim for reimbursement for covered testing.

Find out what your coverage is for OTC at-home tests based on your plan.

Medi-Cal members: Do not submit any claims to Blue Shield Promise.

I paid out-of-pocket for a COVID-19 test that should be covered. What do I need to do?

If you paid the provider at the time of your appointment, the healthcare provider should give you a refund after Blue Shield reimburses them. If you did not receive a refund from your provider, please contact their office.

If your provider has not submitted a claim to Blue Shield for you, visit our How to file a claim page to learn more.

For out-of-network providers:

Some out-of-network providers may charge added fees. Please choose in-network locations for testing to avoid paying any extra fees

Test-related fees: Most plans cover all fees related to the administration of the COVID-19 test during the public health emergency. Some self-funded group plans may not cover all the costs when seeing an out-of-network provider. Members are responsible for any fees or tests that are not covered by their plan.

Unrelated fees: These are other fees that may be charged for your visit, but are unrelated to the test itself. These may include fees for other tests or other services unrelated to the COVID-19 test. Members may have out-of-pocket costs for unrelated fees, depending on their plan benefits. To avoid paying any extra fees, please use network locations for testing.

We will mail you an explanation of benefits that outlines what Blue Shield paid and what remaining balance you may owe, if any. Please be aware that this statement is not a bill.

Coverage for out-of-network testing will change when the public health emergency ends.

I received a check from Blue Shield. What should I do with it?

If you haven’t yet paid the provider, the check goes to the provider. Contact the provider to find out how they want to be reimbursed.

Please note that if you have previously visited an out-of-network provider and received a check payment from Blue Shield, our process has changed. Those payments will now go directly to the provider. The provider should mail you a refund check.

We will mail you an explanation of benefits that outlines what Blue Shield paid and what remaining balance you may owe. Please be aware that this statement is not a bill.

Have more questions about testing coverage?

Call the customer service number on your member ID card.