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Update on Out of Pocket Costs of COVID-19 Tests

February 13, 2022

Update on Out of Pocket Costs of COVID-19 Tests: Medicare Recipients Will Soon Be Eligible for Free At-Home COVID-19 Tests

The new year found Americans mired in the peak of yet another SARS-CoV-2 wave, with the preceding holiday season scarred by overstretched health care systems and testing capacity. In response, the Biden administration has increased the accessibility of at-home COVID-19 tests on multiple fronts.

In January 2022, all US households became eligible to request four free rapid COVID-19 tests either via the website, COVIDTests.gov, or by calling 800-232-0233. 

At the same time, the government also mandated that private health insurers cover up to eight at-home antigen tests per month, per covered individual, with reimbursement capped at $12 per testing kit (two tests per kit). Out of pocket costs vary between ~$10-25 per kit. Typically, the insurance provider will cover the upfront cost for in-network pharmacies and retroactively reimburse members who buy test kits from out-of-network pharmacies.

Although Medicare was not initially included in the coverage mandate, at the beginning of February the Biden administration announced that Medicare beneficiaries, including Medicare Advantage, would also become eligible for eight free at-home COVID-19 antigen tests per month, beginning in the early spring. 

The expanded coverage will include over 60 million Americans, many of whom fall into the higher risk health category.

Medicaid recipients already have full coverage of at-home COVID-19 tests (8 per month).

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