Medicare will cover these tests if you have Part B, including those enrolled in a Medicare Advantage plan.

If you are in a Medicare Advantage plan, the tests covered under this initiative will be covered outside of your existing plan’s coverage, and in addition to any over-the-counter tests that may be covered under the plan as a supplemental benefit.

Medicare won’t cover over-the-counter COVID-19 tests if you only have Medicare Part A (Hospital Insurance) coverage, but you may be able to get free tests through other programs.

Coverage starts April 4, 2022, and continues until the COVID-19 public health emergency (PHE) ends. People with Medicare Part B can get up to eight free over-the-counter tests.

You can get over-the-counter COVID-19 tests at any pharmacy that participates in this initiative. A partial list of participating pharmacies can be found at https://www.medicare.gov/medicare-coronavirus. You should bring your red, white, and blue Medicare card to get your free tests (even if you have a Medicare Advantage Plan or Medicare Part D plan), but the pharmacy may be able to get the information it needs to bill Medicare without the card.

No. You can get your free over-the-counter COVID-19 tests from any eligible pharmacy that voluntarily participates in this initiative.

No, you won’t have to pay as long as you go to an eligible pharmacy that participates in this initiative. However, if you get more than the eight covered over-the-counter COVID-19 tests in any calendar month, Medicare will not pay for additional tests. You may be responsible for the cost of additional tests that calendar month, unless you have additional health coverage.

No. Medicare coverage and payment begins on April 4, 2022, and is available for up to eight over-the-counter COVID-19 tests per calendar month you receive from a participating pharmacy. Medicare will not provide payment for over-the-counter COVID-19 tests obtained prior to April 4, 2022.

Starting April 4, 2022, this initiative covers up to eight over-the-counter COVID-19 tests each calendar month. If you’ve gotten eight of these tests in the current calendar month, you will need to wait until the beginning of the next calendar month to get more tests.

For example, if you receive eight over-the-counter COVID-19 tests on April 14, 2022, through this initiative, you will not be eligible for another round of eight free over-the-counter COVID-19 tests until May 1, 2022. Note that there can be multiple tests per box, An individual test = 1 nasal swab + 1 test card +1 reagent bottle.

No. Medicare cannot process a claim submitted by you directly for a COVID-19 over-the-counter test. You should check whether your pharmacy is participating in the initiative, in which case they will bill Medicare for the over-the-counter test on your behalf.

Medicare will pay for up to eight free over-the-counter COVID-19 tests per calendar month through this initiative as long as the COVID-19 public health emergency continues.

Effective January 15, 2022, commercial, self-funded groups, and Federal Employee Plan members will be able to acquire over the counter COVID-19 tests for free. Eligible members will be able to acquire up to eight over-the-counter tests at no cost per 30-day period. Federal Employee Plan members will be able to acquire up to eight over-the-counter tests at no cost per calendar month. An individual test = 1 nasal swab + 1 test card + 1 reagent bottle.

Each person can obtain up to eight over-the-counter tests at once every 30 days.

There is no age limit.

• Medicaid and Health and Recovery Plan (HARP) members are eligible for two no-cost, over-the-counter tests per week (up to eight per month) if the tests were purchased on or after Jan. 27, 2022. An individual test = 1 nasal swab + 1 test card + 1 reagent bottle.
• Essential Plan members are eligible for four no-cost, over-the-counter tests per week. An individual test = 1 nasal swab + 1 test card + 1 reagent bottle.

No. Testing that is ordered or performed solely for purposes of pandemic control or re-opening the economy, and not based on a determination by an attending provider that the test is medically appropriate for the diagnosis and treatment of an individual is not covered under the member’s health benefit. This includes tests performed on someone with no symptoms to assess health status as required by parties such as a government/public health agency, employer, school, or camp.

Please note that free COVID-19 testing is available at locations across the state operated by the New York State Department of Health.  Individuals do not need to be symptomatic or essential workers to obtain a test from these state sites.  For more information, call the health department’s 24-hour hotline at 1-888-364-3065.

Some health centers and pharmacies are also offering low or no cost testing. For testing sites, visit the U.S. Department of Health & Human Services website, New York State Department of Health website, or call the health department’s 24-hour hotline at (888) 364-3065.