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Frequently Asked Questions: At-Home Testing Kits

Important note: Insurers, including HAP, cannot control the supply and availability of at-home testing kits. Many pharmacies and retailers continue to experience supply delays that are beyond their/our control.

A complete list of at-home testing kit guidelines can be found on the Centers for Medicare and Medicaid Services (CMS) website.

How to get free at-home COVID tests from the federal government

Every home in the U.S. is eligible to order four (4) free at-home COVID-19 tests. Details can be found at covidtests.gov.

Eligibility

Coverage

Purchasing and Reimbursement

For Medicare & Medicaid Members


Is HAP covering the cost of at-home testing kits?

In accordance with federal guidelines, private health insurers, including HAP, are required to cover up to eight (8) at-home over-the-counter (OTC) COVID-19 diagnostic tests authorized by the U.S. Food and Drug Administration (FDA) beginning January 15, 2022 for members in Commercial health plans.


Who is eligible?

HAP will cover the cost of at-home tests, as noted above, for its Commercial members. This includes members of HAP’s large and small employer group plans (including self-funded plans), as well as individual members who purchase their own health plans.

Those not included in this program are Medicaid, Dual Special Needs (D-SNP) and Medicare members, including those with Medicare coverage through a group plan (such as an employer-sponsored Medicare plan). Information for Medicare and Medicaid members can be found below.


How many tests are covered?

In accordance with federal guidelines, HAP will cover up to 8 at-home tests per member per month. If a kit contains multiple tests, each test counts as one. So, a kit with two tests in it would count as two tests toward the eight.


If I don’t purchase 8 tests in a month, can that carry over into the following month?

No, there is no carryover allowance. The limit is 8 tests per calendar month per Commercial member.


If a doctor orders me to be tested, does that count toward my monthly limit?

No. COVID-19 diagnostic tests that are ordered or administered by a health care provider do not count toward your limit of 8 tests per month. In most cases, HAP covers the cost of tests ordered by a health care professional with no cost share to the member.


Will HAP reimburse me for more than 8 test per month if my employer requires regular testing as a condition of my employment?

No. In accordance with state and federal guidelines, HAP does not cover the cost of testing required by employers.


Which at-home tests are covered by HAP?

HAP will cover the cost of over-the-counter at-home test kits that are authorized by the FDA. The FDA maintains a list of approved antigen diagnostic tests and approved molecular diagnostic tests on its website.


Can I buy tests for my whole family at one time?

HAP will cover the cost of up to 8 tests per member per month, regardless of whether they are purchased all at once or at separate times during that month. Retailers and pharmacies are responsible for ensuring eligibility; they may require that members are present or may have other policies to ensure eligibility. HAP is not responsible for the policies of retailers.


Do the free government test kits count toward my monthly limit?

No. In accordance with federal guidelines, HAP will cover up to 8 FDA-approved at-home tests per member per month for eligible members. In addition, every home in the U.S. is eligible to order four (4) free at-home COVID-19 tests. Details can be found at covidtests.gov.


How do I purchase at-home testing kits that are covered by HAP?

Directions for how to be reimbursed can be found below.

To access the list of HAP’s preferred pharmacy network, click here.

HAP is working diligently toward having a direct claims process, whereby members will be able to show their card at preferred pharmacies and incur no out-of-pocket costs for approved test kits. These FAQs will be updated as soon as that process is in place.

Insurers, including HAP, cannot control the supply and availability of at-home testing kits. Many pharmacies and retailers continue to experience supply delays that are beyond their/our control. If testing is needed urgently, coverage continues to be available for tests ordered by health care providers in most cases.

Every home in the U.S. is eligible to order four (4) free at-home COVID-19 tests.  Details can be found at covidtests.gov.


If HAP’s preferred providers don’t have any kits available, can I purchase one elsewhere?

If you purchase a kit from Pharmacy Advantage, HAP’s preferred home delivery provider, you should incur no out-of-pocket costs. FDA-approved OTC kits purchased at other preferred providers or at non-preferred providers will be reimbursed by HAP, according to the criteria listed in these FAQs. Directions for reimbursement are below.

Every home in the U.S. is eligible to order four (4) free at-home COVID-19 tests.  Details can be found at covidtests.gov.


How do I get reimbursed by HAP?

To receive reimbursement for a testing kit purchased Jan. 15, 2022, or later, you must submit your receipt along with the completed and signed reimbursement form that shows the purchase date, test kit name, UPC or SKU code (from box or label), cost of the kit, number of tests within each kit and where it was purchased. That form can be accessed here.

Submit the completed reimbursement form and receipt to:

HAP Claims Division
Pharmacy Reimbursement
2850 W. Grand Blvd.
Detroit, MI 48202


How long will it take to be reimbursed by HAP?

Please allow a minimum of 14 days for processing. It’s possible there could be delays due to the volume of requests received.


I bought some at-home testing kits prior to Jan. 15. Can I be reimbursed?

No. In accordance with federal guidelines, HAP will cover the cost of approved testing kits (as noted above) beginning Jan. 15, 2022. Kits purchase prior to that date are not eligible for reimbursement.


If I’m traveling or living outside of Michigan, are my at-home tests covered?

Yes. If you are traveling or living outside of the state of Michigan and purchase a testing kit from a non-preferred provider, submit your request for reimbursement as noted above.


I’m a Medicare member. How do I get an at-home over-the-counter COVID-19 test and is this test covered?

Every home in the U.S. is eligible to order four (4) free at-home COVID-19 tests.  Details can be found at covidtests.gov.

In addition, the U.S. Department of Health and Human Services (HHS) is providing up to 50 million free, at-home tests to community health centers and Medicare-certified health clinics for distribution at no cost to patients and community members. You can learn more about this program here.

Other at-home tests purchased by individual Medicare members are not covered by HAP and are not eligible for reimbursement.


How are at-home testing kits covered for Medicaid?

The Michigan Department of Health and Human Services (MDHHS) has set specific guidelines for Medicaid members. For these members:

  • A prescription from an authorized health care professional is required.
  • The test must be dispensed and billed to HAP by a Medicaid-enrolled pharmacy.
  • The health care professional authorizing the prescription must be a Medicaid-enrolled doctor, physician assistant, nurse practitioner or pharmacist.
  • The test must be one of the FDA-approved products authorized by MDHHS listed here.
  • Coverage is limited to one test per day.

If the above criteria are met, HAP will cover the cost of the test at no cost to the Medicaid member.

In addition, every home in the U.S. is eligible to order four (4) free at-home COVID-19 tests.  Details can be found at covidtests.gov.

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