Are COVID-19 tests covered?

During the federal 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 for tests that meet the above requirements will be waived during the federal public health emergency. This continues only if state and federal mandates for the coverage of testing without out-of-pocket costs (copays, coinsurance, or deductibles) still 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.

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 California Department of Managed Health Care’s (DMHC) 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.

 

What are the differences between diagnostic tests?

All tests may vary in their accuracy. This can depend on: How specimens are collected and handled Time between exposure and testing How much virus is present The lab and manufacturer of the test kit PCR (polymerase chain reaction) tests done in a laboratory are considered to be the most accurate option. But they generally take longer. This is due to having to send them to the lab and then taking several hours to complete.

LAMP tests are considered to have similar accuracy to PCR tests in most cases. Antigen tests are the most common type of rapid or point-of-care tests and are typically much faster and cheaper than PCR or LAMP tests. But they also tend to be less accurate when the result is negative, also known as the test specificity. 

This means that you may get a “false negative” result. For example, your rapid test may show you are negative for an active COVID-19 infection. But a PCR test may show that you are in fact positive. Talk to your doctor before using a rapid antigen test. You should ask them:

  • If it's the right test for you
  • What the results might mean

 

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

Members with symptoms or known exposure or medically necessary

No. 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

The cost share waiver applies only if state and federal mandates for testing coverage without out-of-pocket costs still apply.

Members without symptoms or known exposure and no provider order

Essential workers

If you are a DMHC-defined essential worker enrolled in an individual and family or group plan regulated by the DMHC 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.

Non-essential workers

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 at no out-of-pocket cost to you from Blue Shield and Blue Shield Promise.

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 an eligible individual and 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 do not fall into one of the categories listed above, 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. 

 

I called Teladoc and they referred me to a testing location. Can I get a COVID-19 test at that location? Will it be covered?

Teladoc is unable to order COVID-19 tests at this time. If the Teladoc provider suggested that you get tested due to your symptoms:

  • Please contact your primary care physician (PCP).
  • You can also call another healthcare provider licensed to order COVID-19 tests.

Your test will be covered at no cost to you during the public health emergency with an order from your PCP or the other provider.

Teladoc may have shared information for testing locations during your telehealth visit.

  • But you may be responsible for out-of-pocket costs for the test. This can apply even if you have symptoms.
  • To avoid out-of-pocket costs, talk to your PCP or a healthcare provider licensed to order COVID-19 tests before visiting any testing locations.
  •  Teladoc doctors are unable to tell you which testing locations are in network for Blue Shield and Blue Shield Promise members.
  • Remember, if you get a test at an out-of-network location, you may pay more out of pocket.

It’s best to contact your PCP or a healthcare provider licensed to order COVID-19 tests. You should also get your test at a network location. This will ensure your test is covered and minimize your out-of-pocket costs.

 

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 get a home test kit from LabCorp?

Blue Shield is working with LabCorp to provide home test kits only for eligible essential workers as they are defined by the DMHC who do not have symptoms (are asymptomatic) and do not have known or suspected exposure to COVID-19.

Asymptomatic essential workers, who are at least 18 years old, must order a home testing kit through Blue Shield’s LabCorp order page only to ensure coverage. If you try to order a home test kit directly from LabCorp or any other online lab using their general test kit webpage, you may be charged for the test and may pay more out-of-pocket.

LabCorp will send you a home test kit by overnight delivery through FedEx. You can collect your own sample and return the test kit in the provided packaging. Check with your local FedEx for pick up and drop off schedules. You will receive your results within approximately 1 – 2 days from when your sample is received at LabCorp.  

Even if you are an essential worker, this order site should not be used if you have symptoms or known exposure to COVID-19. If this is the case, you should contact your healthcare provider.

Members who are non-essential workers are not eligible to order home test kits through this link, even if they have no symptoms or known exposure.  

 

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 more questions about coverage? 

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