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Over-the-counter COVID-19 at-home test reimbursement FAQ

Starting with tests that are purchased on or after Jan. 15, 2022, Moda Health will cover over-the-counter (OTC) COVID-19 at-home tests for members on individual and employer group plans with medical and/or pharmacy coverage.

When should I take an at-home test?

You may choose to take an at-home test if you have symptoms of COVID-19 or have been exposed to someone with COVID-19. An at-home test may confirm if you have COVID-19.

If your employer requires you to get tested, please note that Moda Health does not cover testing for employment purposes.

How can I get a free OTC at-home test or purchase one for reimbursement?

  1. Show your Moda Health ID card at an in-network pharmacy counter when purchasing your test.
  2. Reimbursement options are available when OTC COVID-19 at-home tests that are FDA authorized or approved are purchased at one of our in-network pharmacies or at an authorized retailer (in-person or online).

It is important to note that there are two different reimbursement forms. One is used when seeking reimbursement for tests purchased at a pharmacy or online pharmacy. A different form is used when seeking reimbursement not at a pharmacy (i.e., in-person or online retailer).

In-network pharmacy option: (in-person)

Purchasing an OTC COVID-19 at-home testing kit at one of our in-network pharmacies may require no reimbursement form at the pharmacy counter. Simply take the kit and your Moda Health member ID card to the pharmacy counter. The test will be covered at 100% and no reimbursement form is necessary. If the pharmacy charges you for the OTC at-home testing kit, you can use this claim form for reimbursement.

If you choose to purchase online at one of our in-network pharmacies, you should keep a copy of your itemized receipt and use this claim form. Then, follow the instructions to submit the form. Please note that you do not need to complete the NPI or NDC if that is unknown.

At a retailer or online retailer: (not a pharmacy)

You are able to purchase an OTC COVID-19 at-home testing kit at an authorized retailer or online retailer. You should provide a copy of your itemized receipt and fill out the OTC COVID-19 at-home test medical reimbursement form.

Where can I find a COVID-19 at-home test?

To find in-network pharmacies, use our Moda Pharmacy Search.

Are there limits to the reimbursement amount?

Following federal regulations, Moda Health will reimburse you up to $12 per test for tests purchased on Jan. 15, 2022, or later. We will reimburse up to eight (8) tests per 30 days for each person on a Moda Health plan, no matter if the tests are bought all at once or at separate times during the 30-day period. Moda will cover up to eight tests if they are bought individually or in a pack that includes multiple tests.

Please note that shipping costs do not apply to reimbursement.

Why can't Medicare members get coverage for at-home tests?

Currently, Medicare pays for COVID-19 tests performed by a lab, such as PCR and antigen test, with no cost sharing to the member when the test is ordered by an authorized healthcare professional. Moda Health will continue to follow federal reimbursement guidance.

I think I may have COVID-19 but I can't find an at-home test? What do I do?

Supply chain issues continue to be a reality during the COVID-19 pandemic. As the system works through these issues, testing sites and testing clinics are another option. However, you will want to be aware of the costs. Some locations offer free tests and others may charge you. The cost varies by location and may or may not be covered by Moda. Visit your state health website to find a testing location near you.

I purchased COVID-19 at-home test prior to Jan. 15. Is it covered for reimbursement?

We are not covering tests that were purchased prior to Jan. 15, 2022. We will cover tests purchased or ordered on and after Jan. 15.

What will I receive at the time of reimbursement?

You will receive a check in the mail, along with an explanation of payment.

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