COVID 19 Rapid Antigen Test

Prescription Plan Update: Changes in Over-the-Counter Covid Test Coverage



The Joint Health Management Board’s (JHMB) goal is to keep you, as a plan enrollee, up to date on the latest changes to your health coverage.

As of November 12, 2023, your access to over-the-counter (OTC) COVID tests may change depending on your health insurance plan. Learn if this affects you below.

Ending of COVID Public Health Emergency

The national COVID Public Health Emergency (PHE) ended May 11, 2023. During the PHE, insurance plans were required to cover COVID tests, both in-network and out-of-network, for free. Plans were also required to provide enrollees with eight free OTC COVID tests per 30-day period.

Due to state law requirements for fully insured plans, Kaiser Permanente® extended PHE coverage through November 11. JHMB also extended the same coverage for all self-insured plans (PPO Plans A and B), along with Aetna® Medicare Advantage PPO Plan and Aetna Open Choice PPO Plan. However, that extension expired on November 11, 2023. Depending on your health insurance provider, your access to free OTC COVID tests may have changed.

If You Are a Kaiser Permanente HMO Plan C Enrollee

After November 11, 2023, commercially insured members with Kaiser HMO Plan C can continue receiving COVID-19 care at no cost when provided in the Kaiser Permanente network. This includes up to eight home antigen tests per member, per month.

If you choose to get a COVID-19 vaccine, testing, or drug therapy outside of Kaiser Permanente, you will be responsible for cost-sharing unless these services are delivered as part of covered urgent or emergency care. Members may submit claims to get reimbursed for the costs paid for services outside the Kaiser Permanente network. For many members, reimbursement could be less than 50% of the cost of the services provided.

If You Are a Kaiser Permanente Senior Advantage Enrollee

In-network COVID-19 care for Kaiser Permanente Senior Advantage enrollees is similarly covered. However, out-of-network COVID-19 care that you receive is not reimbursable.

If You Are an Aetna PPO Plan A or PPO Plan B Enrollee

Participants of Aetna PPO Plan A or PPO Plan B, may still continue to receive up to eight free tests from in-network providers per month through Elixir.

If you are enrolled in one of these plans, out-of-network OTC tests are not covered anymore—you will have to pay the retail cost of these tests.

If You Are an Aetna Open Choice PPO or Medicare Advantage PPO Enrollee

If you are enrolled in the Aetna Open Choice PPO plan or Medicare Advantage PPO plan, OTC COVID tests are no longer covered, whether in-network or out-of-network.

For these plans, you will pay the retail cost of test kits. You will be able to get an at-home test kit for around $12 per test or $24 for a box of two tests from CVS® and other retailers. You are still able to use funds from a health savings account or flexible spending account toward test kits.

COVID testing is only covered for Aetna Open Choice PPO or Medicare Advantage PPO plan enrollees when ordered by a physician or other health care providers, such as physician assistants and nurse practitioners, and sent to a lab for processing. The Medicare Advantage plan does not cover rapid tests or self-tests, including OTC test kits.

Regardless of your plan, you may still receive free at-home COVID tests through the U.S. government.

If you have any questions about the coverage of a specific COVID test, please contact your insurance provider directly.

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