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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 free at-home COVID-19 tests. Details on quantities and how to order 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?

As of January 15, 2022, 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) per month (defined as a 30-day period) 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.

As of April 4, 2022, Medicare covers up to eight (8) over-the-counter test kits each calendar month at no cost to the member.  This coverage will continue until the COVID-19 public health emergency ends.  These tests are covered for all Medicare members, including those with Medicare Advantage and Medigap plans.  The tests are covered through original Medicare Part B (medical insurance), not your private health insurer (HAP), so you may need to show your red, white, and blue Medicare card at the pharmacy to get your free over-the-counter test kits.  Additional information for Medicare members can be found below. 

Medicaid, Dual Special Needs (D-SNP) and MI Health Link MMP (Medicare-Medicaid Plan) members have a different set of guidelines for coverage under Medicaid, set by the State of Michigan, on how to receive at-home test kits. Information for these members can be found below.

Important note: Medicaid members, including D-SNP and MMP, are NOT eligible to be reimbursed for any out-of-pocket costs associated with purchasing at-home test kits. These members should follow the guidelines below and make sure the pharmacy is billing HAP directly (see instructions for Medicaid members below).

How many tests are covered?

In accordance with federal guidelines, HAP will cover up to 8 at-home tests per member per month (defined as a 30-day period). 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.

A month is defined as a 30-day period between “purchases.”  For example, if a member receives 8 covered tests on January 15, they are not eligible to receive any additional covered tests until February 15.  If a member receives 6 kits on August 1 and two more on August 15, they are eligible to receive 6 more kits as of Sept. 1 and two more as of Sept. 15.  And so on.

Is there a price limit on the covered tests?

If you purchase a test from a pharmacy in our preferred network, you will have no cost sharing. If you purchase a test outside this network, in accordance with federal guidelines, HAP will reimburse members at a rate of up to $12 per individual test (or the cost of the test, if less than $12).

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 Commercial member per 30-day period.

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 authorized 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 (defined as a 30-day period), regardless of whether they are purchased all at once or at separate times during that 30-day period. 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 30-day period for eligible members. In addition, every home in the U.S. is eligible to order free at-home COVID-19 tests. Details on quantities and how to order 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. Using a preferred pharmacy or mail order through Pharmacy Advantage are the easiest ways to get kits without incurring any out-of-pocket costs because they will make sure your kits are FDA-approved and are covered by HAP.

HAP has a network of preferred pharmacy providers. When purchasing or ordering an FDA-approved kit from a preferred provider, show your HAP ID card and the provider will bill HAP directly. You should incur no out-of-pocket cost. To access the list of HAP’s preferred pharmacy network, click here.

To request an at-home test kit via mail order from Pharmacy Advantage (HAP’S preferred home delivery provider), click here. Submit as a general request with the subject “Other” and include the message: “Would like to request (number of kits you're requesting) OTC COVID Test kits.” A Pharmacy Advantage team member will contact you to gather all necessary information and process your request. Estimated fulfillment time is 5 to 7 business days, if kits are in stock.

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 free at-home COVID-19 tests.  Details on quantities and how to order 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 free at-home COVID-19 tests. Details on quantities and how to order can be found at covidtests.gov.

What if a preferred pharmacy or provider tries to bill me?

A participating provider should always bill HAP directly. However, if you pay for the FDA-approved test, submit your receipt to HAP (instructions are below).

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:

Health Alliance Plan
Pharmacy Reimbursement
2850 W. Grand Blvd.
Detroit, MI 48202

This reimbursement applies only to HAP commercial members, which 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.  Medicare and Medicaid members are not eligible for reimbursement and should see FAQs below for directions on how to obtain test kits.

How long will it take to be reimbursed by HAP?

Please allow a minimum of 30-35 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 free at-home COVID-19 tests. Details on quantities and how to order can be found at covidtests.gov.

In addition, as of April 4, 2022, Medicare will cover up to eight (8) over-the-counter COVID-19 tests each calendar month at no cost to the member.  Medicare will cover these tests if you have Part B coverage, including those enrolled in Medicare Advantage or Medigap plans.

The tests are covered through original Medicare Part B (medical insurance), not your private health insurer (HAP), so you may need to show your red, white and blue Medicare card at the pharmacy to get your free over-the-counter test kits.

Detailed information about this program can be found on the Centers for Medicare and Medicaid Services (CMS) website by clicking here.

A list of participating pharmacies can be found on the Medicare.gov website by clicking here.

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, including members with Medicare Supplement plans (Medigap), are not covered by HAP and are not eligible for reimbursement.

Dual Special Needs (D-SNP) and Medicare-Medicaid Plan members have both Medicare and Medicaid coverage. COVID-19 tests are covered under Medicaid for these members under the State of Michigan’s Medicaid guidelines. Information for these members can be found below.

How are at-home testing kits covered for Medicaid, D-SNP and MI Health Link MMP members?

The Michigan Department of Health and Human Services (MDHHS) has set specific guidelines for Medicaid members, which includes Dual Special Needs (D-SNP) and MI Health Link MMP (Medicare-Medicaid Plan) members. D-SNP members must have Medicaid coverage through HAP to be eligible for Medicaid coverage of tests.

  • 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 kit contains two tests, the pharmacy can bill it as a two-day supply. 

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 free at-home COVID-19 tests. Details on quantities and how to order can be found at covidtests.gov.