How to Get Reimbursed for At-Home COVID Tests in California

Updated 1:30 p.m. Wednesday

Winter in California has begun with foggy mornings, rainy nights and planning holiday dinners with family and friends. And like the past few winters, we’re also seeing COVID-19 infections creep back up across the state despite less free and easily accessible testing sites.

In early November, 6.2% of the PCR tests for COVID-19 administered in California came back positive, according to the state’s most recent data showing the seven-day average of those positivity rates. One month later, the state’s most recent data from Dec. 4 shows that this rate has climbed to 8.8%.

The rate of positive COVID-19 tests has increased every winter since the start of the pandemic. In January 2022, the infection rate surpassed 20%, partly due to the spread of the powerful omicron variant. During that time, one out of every five tests administered in the state came back positive.

Even if you’re up to date with your vaccines and have received the new updated COVID-19 vaccine, it’s perfectly normal to feel still anxious about the coronavirus, especially if you plan to spend time with family and friends during the holiday season. On Nov. 30, public health officials from all nine Bay Area counties published a list of recommendations to prevent respiratory infections (COVID-19, RSV and the flu) during the holidays. Among these recommendations is stocking up on at-home COVID-19 tests.

The federal government is still giving out four free COVID-19 tests to every household. And yes, for many families four tests may just not be enough, especially considering that the high season for COVID-19 infections lasts several months. However, many insurance companies in California will still reimburse you for at-home tests you buy at the store or pharmacy.

The process of reimbursing for at-home COVID-19 tests has changed in the last month, and each insurer is reimbursing members differently. KQED reached out to every major health insurance company in California to learn what they’re doing and what members need to know.

What rules have changed for health insurance companies?

At the start of 2022, the federal government required insurers to reimburse their members for up to eight monthly at-home COVID-19 tests, regardless of where those tests were purchased. That federal rule lasted for over a year and ended in May 2023, when the federal state of emergency ended — but in California, state law extended it for six more months until Nov. 11.

Nov. 11 has come and gone, and there are some new rules to keep an eye out for.

Insurers are still required to reimburse members for up to eight at-home tests as long as these tests are now obtained “in-network” with your insurer. However, other insurers will continue to reimburse you for tests regardless of where you buy them.

Of course, each insurance company does this a little differently — so make sure you know what’s available for you according to your plan before buying a test. And if you’re in any doubt, contact your insurer directly to find out what you’re eligible for before you purchase any tests.

How does my insurance company handle reimbursements for at-home COVID-19 tests?

Kaiser Permanente

Before Nov. 11, Kaiser Permanente members could buy at-home tests from any pharmacy or store and get reimbursed by completing a form. That process is no longer in place. Kaiser Permanente told KQED: “ If members get a COVID-19 vaccine, testing, or drug therapy outside of Kaiser Permanente after Nov. 11, they’ll be responsible for cost-sharing.”

Members, however, can receive up to eight home tests per month at no cost when they go to a Kaiser Permanente pharmacy. You can also order your eight tests online through the member services website, kp.org.

One thing to keep in mind: If you order your tests through kp. org, you are not guaranteed a reimbursement. Kaiser Permanente told KQED that tests ordered through kp.org are “low cost” and members “may be eligible for reimbursement, depending on their plan.” For this reason, it may be worth contacting Kaiser’s membership services (as listed on your insurance card) to double-check your tests will be free when ordered online.

The eight monthly tests are available to each Kaiser member, regardless of age. So if you, your spouse and two children are all covered by Kaiser Permanente, you can order up to 32 home tests each month through kp.org.

Blue Shield of California

Blue Shield continues to fully reimburse policyholders for the cost of up to eight at-home tests each month. “Nothing regarding in-home COVID-19 testing has changed since Nov. 12,” the insurer told KQED.

Members can also buy home tests from anywhere. Unlike other insurance companies, Blue Shield does not have a network of preferred home test brands or providers. Once a member purchases their tests, they must complete a reimbursement claim form and mail it to Blue Shield.

Keep in mind that Blue Shield will only cover the cost of up to eight tests per month, max. You will not be reimbursed for the ninth test if you buy nine tests in one month. And if you are looking to get an in-person COVID-19 test done, for that, you will have to go to an in-network provider so the cost of the test is covered.

Anthem Blue Cross

Anthem Blue Cross has confirmed with KQED that it will continue to reimburse members with certain plans for at-home tests. You can buy the tests from any seller and are not limited to a specific network of test providers.

Keep in mind that there are some plans that do not qualify for reimbursements and based on the information that Anthem Blue Cross provided KQED, it seems that a member will only know if they qualify once they have filed a reimbursement claim.

To file a claim, first, make sure you still have the receipts from when you bought the tests because you will need to submit them later on. If you got the tests online, say through Amazon, you can find an electronic receipt when you go to your purchasing history. Once you have your receipts secured, head over to the Anthem Blue Cross member website. If you use the SydneySM Health app, you can use that too.

Once you’ve logged in, click on “Claims” and select “Submit a Claim,” and that’s where you will complete an electronic form with all the details from your purchase.

And remember that in California, this insurer goes by Anthem Blue Cross, and in other states, it is called Anthem Blue Cross and Blue Shield. Distinguishing between the two is especially important to make sure you get the right benefits that correspond to your insurance plan. For example, Anthem Blue Cross and Blue Shield are no longer reimbursing members for at-home COVID-19 tests in other states, but Anthem Blue Cross, as explained above, is still covering members in California for these tests.

Aetna

Aetna continues to cover the costs of up to eight at-home COVID-19 tests per month. This includes members with Aetna coverage through their employer and those on Medi-Cal.

To get reimbursed, policyholders should log into Aetna’s member website using their insurance plan credentials. Once logged in, click on “Submit a claim for reimbursement.” You’ll then see an electronic form that asks you for certain information, including the location and date of your purchase and a photo or scan of the receipt to verify your purchase.

If you are on a commercial plan and have Pharmacy Benefit coverage, there is a list of pharmacies that Aetna considers “in-network.” To make sure you get a reimbursement for the tests you buy, it’s probably best to buy them at an in-network pharmacy. If you receive Aetna coverage through Medi-Cal, you can buy tests from anywhere, regardless if the seller is in-network or not.

One last thing to keep in mind: Aetna members can currently request reimbursement through an online form. But that option will be discontinued at the end of this year. In 2024, the insurer says that you will need to call Member Services directly to request a reimbursement over the phone.

UnitedHealthcare and Cigna

KQED has repeatedly reached out to UnitedHealthcare and Cigna but has not received an answer from either insurer’s media team. We’ll be updating this story once we have new information.

What if I don’t have health insurance?

Remember, you don’t need health insurance to order four free at-home COVID-19 tests online from the federal government. Read more about how to order four free tests per residential address via USPS.

If you or someone in your community doesn’t have access to the internet to order these free tests, USPS says you can contact their helpline by calling 1-800-232-0233 (TTY 1-888-720-7489). You should also be prepared for potentially long wait times using this helpline.

Other ways of finding a free or low-cost COVID-19 test may still be available, using the CDC’s No-Cost Testing Locator or through your Bay Area county. These tests may be antigen tests or PCR tests. Read more about where to find a free or low-cost test near you.

KQED’s Carly Severn contributed to this story.

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