Are COVID-19 tests covered?

During the public health emergency, Blue Shield and Blue Shield Promise will cover COVID-19 tests and waive out-of-pocket costs for copays, coinsurance, and deductibles for these tests. But the following conditions must be met: 

  • Test must be medically necessary and ordered by a healthcare provider licensed to order COVID-19 tests
  • Test must be FDA-approved, emergency use authorized, or authorized under other guidance from the Secretary of the Department of Health and Human Services consistent with the federal CARES Act
  • The test must be processed in accordance with FDA and other applicable guidance.

Out-of-pocket testing costs will be waived during the federal public health emergency. This remains as long as state and federal mandates for the coverage of testing without out-of-pocket costs (copays, coinsurance, or deductibles) still apply. 

If the test is for an essential worker without symptoms or known or suspected exposure, out-of-pocket costs will apply based on the member’s benefit plan. This means you may be required to pay a copay, coinsurance or deductible for your test as defined by your plan benefits. This is addressed in the DMHC’s emergency regulation.

 

Which types of COVID-19 tests are covered?

The tests below are covered by Blue Shield and Blue Shield Promise only if the above conditions are met:

  • Diagnostic tests (including self-administered or home test kits)
  • Antibody or serology tests when used for diagnostic purposes.

 

Will I have to pay a copay for a COVID-19 test? 

During the federal public health emergency, you do not need to pay a copay, coinsurance or deductible for tests that are ordered by a healthcare provider as medically necessary because: 

  • You have symptoms of COVID-19
  • You think you were exposed to someone who has COVID-19
  • The test is otherwise medically necessary for your situation

If you are a DMHC-defined essential worker enrolled in a DMHC individual, family, or group plan and have no symptoms or known or suspected exposure, you will be required to pay a copay (or other applicable out-of-pocket costs such as coinsurance or deductibles) for your COVID-19 test if it is not ordered by a healthcare provider. To find out what your out-of-pocket costs would be, please check your Evidence of Coverage or plan policy documents. COVID-19 tests fall under your plan’s laboratory services benefit.

For all other circumstances, you will be responsible for the full cost of the test. See What other options are available for free testing? for other low- or no-cost options from the state, county, city or local public health departments. 

 

Can I go anywhere to get a test?

If you have symptoms or think you have been exposed to someone who has COVID-19, contact your healthcare provider. They can tell you where to get a test if needed. During the federal public health emergency, testing that is medically necessary will be covered by Blue Shield and Blue Shield Promise at no out-of-pocket cost to you.

If you have no symptoms and don’t think you have been exposed to COVID-19, you have a few options:

  • If you are a DMHC-defined essential worker enrolled in a DMHC individual, family, or group plan, you may request a test without a healthcare provider order. Out-of-pocket costs (copays, coinsurance or deductibles) may apply based on your plan benefits. Blue Shield recommends that you get tested at a network location to reduce your out-of-pocket costs. If you get a test at an out-of-network location, you may pay more out-of-pocket.
  • If you are not a DMHC-defined essential worker, you will be responsible for the full cost of the test. But state, county, and local public health departments may offer you testing at low or no cost.

See Where can I get a test? for specific location information. 

 

Can I just walk up to LabCorp or Quest Diagnostics to get a COVID-19 test?

Neither LabCorp nor Quest Diagnostics are collecting samples for diagnostic tests. They only collect blood samples for antibody tests with an appointment. This will only be covered by Blue Shield and Blue Shield Promise if you have a healthcare provider order for an antibody test for diagnostic purposes. Antibody tests are not appropriate for diagnostic testing in most cases. These types of tests will not tell you if you have an active infection or are still contagious.

 

Can I go to a pop-up testing site?

Yes. Testing at pop-up sites is covered in certain cases. During the public health emergency, COVID-19 testing at temporary facilities or pop-up testing sites will be covered by Blue Shield and Blue Shield Promise without out-of-pocket costs. This only applies if the test is medically necessary and ordered by a healthcare provider licensed to order COVID-19 tests.

Most of these sites require making an appointment and filling out a screening form. They offer only limited availability for unscheduled visits (walk or drive in). This may result in very long wait times.

If you are a DMHC-defined essential worker without symptoms or known or suspected exposure, you can also go to a pop-up testing site. But you will have to pay out-of-pocket costs (copay, coinsurance, deductible) for the test. Your out-of-pocket costs may be higher if this testing site is not in Blue Shield’s network.

 

If I need to get tested to go back to work, will Blue Shield cover my COVID-19 test?

Only tests ordered by a healthcare provider licensed to order COVID-19 tests will be covered by Blue Shield and Blue Shield Promise at no out-of-pocket cost to you. 

Tests for DMHC-defined essential workers without symptoms or known or suspected exposure will also be covered if you are enrolled in a DMHC individual, family, or group plan. But you will pay out-of-pocket costs (copays, coinsurance or deductibles) for your test based on your benefit plan.  For more details, check Where can I get tested?

In all other cases, tests not ordered by a healthcare provider are not covered. Examples include tests for non-essential workers without symptoms or known or suspected exposure, employment, or health surveillance purposes. Costs for these tests must be paid by the employer, government, or member.

 

If a member gets tested at a pop-up test site without receiving a healthcare provider’s order for the test, will Blue Shield cover the service and waive the member’s out-of-pocket costs?

No. But Blue Shield will cover some of the cost of the test for members who are DMHC-defined essential workers. Essential workers may be required to pay out-of-pocket costs (copays, coinsurance or deductibles) for the test based on their benefit plan terms. For more details, check Where can I get tested?

For members who are not essential workers, tests at a pop-up test site that are not ordered by a healthcare provider are not covered. Examples include tests for non-essential workers without symptoms or known or suspected exposure, employment, or health surveillance purposes. Costs for these tests must be paid by the employer, government, or member.

 

Have questions about coverage? 

Call the phone number on your Blue Shield or Blue Shield Promise member ID card.