COVID-19 Testing

A female healthcare professional gives instructions to a male colleague as they work at a COVID drive through testing site.

COVID-19 Testing

COVID-19 testing is still important. Learn about when you need to get tested, what is covered, and convenient options for testing. Visit your city or state’s COVID-19 sites for information on testing locations in your area: New York CityNew York StateNew JerseyConnecticutPennsylvania. You can also find a community based testing site here.

If you have symptoms of coronavirus (COVID-19), call your doctor. Based on the details of your symptoms, your doctor will let you know whether it’s recommended that you get tested. If you are fully vaccinated, check the most up-to-date CDC guidance for information on testing. Talk to your doctor if you’re not sure.

If you go to an in-network doctor or provider to get tested for the coronavirus (COVID-19):

  • Your diagnostic test and in-person visit to diagnose COVID-19 will be covered by your plan. There will be no cost-sharing, including copays, coinsurance, or deductibles.
  • COVID-19 tests for screening purposes (employment, return to work/school, travel etc…) for Essential Plan* and Child Health Plus** members only, will be covered. These “Point of Care” tests are performed in a doctor’s office, pharmacy, or facility. There will be no cost-sharing, including copays, coinsurance, or deductibles.
  • *Beginning Jan. 3, 2022
    **Beginning Jan. 27, 2022

  • CVS Pharmacy Minute Clinic® offers no-cost COVID-19 testing by appointment throughout the region. Visit their COVID-19 testing page to schedule a test.
  • AdvantageCare Physicians takes care of the whole you, including testing for COVID-19. To learn more, visit ACPNY’s COVID-19 testing page.

If you go to an out-of-network doctor or provider to get tested for the coronavirus (COVID-19):

  • Your diagnostic test and in-person visit to diagnose COVID-19 will be covered by your plan. This includes any doctors outside of our network. There will be no cost-sharing, including copays, coinsurance, or deductibles. Treatment should still be obtained at a facility in our network, unless it is an emergency. If you are admitted to a facility not in our network, your treatment may NOT be covered by your plan. All normal coverage restrictions and cost-sharing charges will apply for care or treatment, including inpatient hospital admissions. Some plans do not cover out-of-network services, so this could include the total cost for services.

If you go to the emergency room to be tested for COVID-19:

  • Your diagnostic test and visit to diagnose COVID-19 will be covered by your plan. There will be no cost-sharing, including copays, coinsurance, or deductibles. Services you get for an emergency room visit will always be covered, if you are admitted to the hospital.

Visit your city or state’s COVID-19 sites for information on testing locations in your area: New York City, New York State, New Jersey, Connecticut, Pennsylvania. You can also find a community based testing site here.

Beginning Dec. 15, 2022, all U.S. households can request four (4) COVID-19 at-home rapid tests to be delivered for free to their home through the United States Postal Service (USPS). Orders will begin shipping Dec. 19, 2022. To order at-home tests, go to www.covidtests.gov.

See the details below to understand if and when at-home, rapid tests are covered by your plan. At a minimum, covered at-home, rapid tests must be purchased over the counter and authorized by the FDA. Many brands sell test kits with more than one test in it.

EmblemHealth Commercial members: As of January 15, 2022, EmblemHealth plans covers eight (8) diagnostic only COVID-19 at-home, rapid tests per member per month (every 30 calendar days), as long as the test is not for employment or other non-covered purposes, such as for return to work.

EmblemHealth Essential Plan members: As of January 3, 2022, EmblemHealth covers two (2) COVID-19 at-home, rapid test kits per week with no out-of-pocket costs. Test kits may include more than one test.

EmblemHealth Medicaid and HARP members: As of February 8, 2022, EmblemHealth covers up to eight (8) COVID-19 at-home rapid tests per month (every 30 calendar days) with no out-of-pocket costs. As of January 10, 2022, an order from a provider is no longer required for such coverage. Additional tests may be covered with an order, when medically necessary.You can find a pharmacy in our network here.

EmblemHealth Child Health Plus members: As of January 27, 2022, EmblemHealth covers two (2) COVID-19 at-home, rapid test kits per week with no out-of-pocket costs. Test kits may include more than one test.

EmblemHealth Medicare Members: All Original Medicare and Medicare Advantage members who have Medicare Part B are now covered for FDA-authorized over the counter COVID-19 at-home rapid test kits. Beginning April 4, 2022, Medicare will cover up to eight (8)tests per calendar month (every 30 calendar days) in Medicare participating pharmacieswith no out of pocket costs. You can visit a Medicare participating pharmacy and show your red, white, and blue Medicare card to receive your tests. Go to the pharmacy website or call the relevant pharmacy listed for details on participating locations and how to order. Visit Medicare’s websitefor more information.

Beginning Dec. 15, 2022, all U.S. households can request four (4) COVID-19 at-home rapid tests to be delivered for free to their home through the United States Postal Service (USPS). Orders will begin shipping Dec. 19, 2022. To order at-home tests, go to www.covidtests.gov.

For most Commercial members, if your plan covers the COVID-19 at-home, rapid tests, you can purchase them at a store, pharmacy, or online where they are available. Then you’ll have to send in some information to be reimbursed. This includes a completed claim form and your receipt. We may send you an attestation to confirm that the test was for a covered purpose. If the test is covered, then you will be reimbursed up to $12 for each test. Here’s instructions on how to fill out the claim form, and important terms and conditions.

You may also directly order the allowed number of COVID-19 at-home, rapid tests from Express Scripts Pharmacy. The tests will then be mailed to your home. It may take up to four weeks to arrive. Sign in to Express Scripts website to place your order. The most common tests ESI ships are BinaxNOW™ and QuickVue®.

You can also go to an in-network pharmacy’s drug counter and show your member ID card to get covered tests with no out-of-pocket costs. You can find a pharmacy in our network here.

Beginning Dec. 15, 2022, all U.S. households can request four (4) COVID-19 at-home rapid tests to be delivered for free to their home through the United States Postal Service (USPS). Orders will begin shipping Dec. 19, 2022. To order at-home tests, go to www.covidtests.gov.

Medicaid, Essential Plan, Child Health Plus and HARP members can receive their allowed number of COVID-19 at-home, rapid tests from an in-network pharmacy. You will pay no out-of-pocket costs when you obtain a test from an in-network pharmacy. You cannot submit a claim for reimbursement to EmblemHealth from an out-of-network pharmacy, store, or online retailer. You can find a pharmacy in our network here.

Beginning Dec. 15, 2022, all U.S. households can request four (4) COVID-19 at-home rapid tests to be delivered for free to their home through the United States Postal Service (USPS). Orders will begin shipping Dec. 19, 2022. To order at-home tests, go to www.covidtests.gov.

Beginning April 4, 2022, Medicare will cover up to eight (8) tests each calendar month (every 30 calendar days) in Medicare participating pharmacies with no out of pocket costs. You can visit a Medicare participating pharmacy and show your red, white, and blue Medicare card to receive your tests. Go to the pharmacy website or call the relevant pharmacy listed for details on participating locations and how to order. Visit Medicare’s website for more information.

For most members, testing for return to work or school, travel, or other recreational activities is not covered by your plan. EmblemHealth continues to cover medically appropriate FDA-authorized COVID-19 tests if your doctor thinks you may have COVID-19 or you were exposed to COVID-19 and orders the test. You will not have any cost-sharing, including copays, coinsurance, or deductibles for covered tests. If you’re not sure if your test will be covered, call us at the number on the back of your ID card. 

Beginning Jan. 3, 2022, COVID-19 tests for screening purposes (i.e., employment, return to work/school, travel etc…) for Essential Plan and Child Health Plus members only, will be covered. These “Point of Care” tests are performed in a doctor’s office, pharmacy, or facility. There will be no cost-sharing, including copays, coinsurance, or deductibles.

If your doctor or licensed health care professional sends you to get your antibodies checked for COVID-19 because it is clinically indicated, your visit and FDA-authorized test will be covered. There will be no cost-sharing, including copays, coinsurance, or deductibles.

We encourage our members to use Quest Diagnostics or Labcorp for their testing. Quest and Labcorp are EmblemHealth’s in-network, preferred lab and testing providers.

Antibody testing for return to work or school, travel, or other recreational activities is not covered by your plan. EmblemHealth only covers non-diagnostic antibody tests when these services are delivered according to the terms of your benefit plan. If you’re not sure if your test will be covered, call us at the number on the back of your ID card.

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