Widespread diagnostic testing for COVID-19 is an essential part of efforts to control the pandemic. Free or low-cost testing is key to ensuring accessibility for everyone who needs to be tested.
A COVID-19 test can cost anywhere from $23 to $2,315 in the U.S., with the average price costing around $100. This disparate price range is the result of a lack of federal regulations for healthcare prices. Because there are no national guidelines or oversight for healthcare prices, individual labs and healthcare providers can set whatever prices they want for their products and services, including COVID-19 tests.
The good news is that, in most cases, these charges are not being passed on to individuals who get tested for COVID-19. The actual amount that someone has to pay for a COVID-19 test varies, and depends on a few factors, including whether the individual has health insurance, the state in which they live, the lab that runs the test, and whether the test is deemed “medically necessary.”
Because of these variances in price, specific questions about what, if anything, you will pay for a COVID-19 test should be directed to the healthcare provider, clinic, or testing site that is administering the test.
Technically, yes. According to the Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief, and Economic Security (CARES) Act, both of which were passed in March, all public and private health insurance plans, including self-funded plans, Medicare, and Medicaid, must cover FDA-approved diagnostic tests for COVID-19. This legislation stipulates that insurers must cover the full cost of the test, with no deductibles or copays, and that they must do so for both in-network and out-of-network doctors and labs.
However, there are some caveats. First, a healthcare provider must deem the test “medically necessary.” This means that individuals must have a referral from a primary care physician or other healthcare provider. While referrals have been standard procedure at most testing sites since the beginning of the pandemic, this requirement is something of a gray area, especially for individuals who are asymptomatic, or only have mild symptoms.
Also, new guidance on the laws released in June confirmed that insurers do not have to cover routine diagnostic tests required by employers or other institutions as part of screening efforts to safely reopen. However, insurers must cover the cost of multiple rounds of testing if it is deemed medically necessary. The question of who should pay for employees’ testing to confirm that people can safely return to work has been an ongoing issue throughout the pandemic.
Another potential issue is that, while insurance may cover the cost of the COVID-19 test itself, individuals may have to pay copays or a deductible for other costs associated with the COVID-19 test. This can include charges for the doctor’s appointment, or additional testing to rule out other illnesses that are similar to COVID-19.
Lastly, these guidelines are only in place so long as the COVID-19 public health emergency declaration remains in effect in the U.S.
The federal government has put some provisions in place for uninsured individuals to get tested for COVID-19. An amendment to the FFCRA created an optional Medicaid eligibility pathway that states can use to get reimbursed for testing uninsured individuals for COVID-19. The Kaiser Family Foundation is tracking which states have opted into this expanded coverage for COVID-19 testing.
The government also established the COVID-19 Claims Reimbursement to Healthcare Providers and Facilities for Testing and Treatment of the Uninsured Program. With this program, the federal government has set aside $2 billion to reimburse healthcare providers for tests for individuals who do not have health insurance. However, participation in this program is voluntary, so individuals should first confirm with a healthcare provider or testing site that they are participating in the program, and that the cost of their test will be covered.
In certain instances, yes. On occasion, some cities and states have been offering free COVID-19 testing to all individuals, regardless of their insurance status. In some places, such as Wisconsin, free testing has been ongoing, while other areas, like Seattle, San Francisco, and Denver offered free testing temporarily following protests in those cities.
When you make an appointment for a COVID-19 test, or go to a walk-up site, talk to your healthcare provider about how much the test costs, what your insurance will cover, what out-of-pocket costs you may have to pay during your visit, and what forms of payment they accept. Generally speaking, regardless of where you are tested, you should bring your personal ID and insurance card.
You can also contact your insurance provider directly if you have questions about coverage for COVID-19 testing. In most cases, your healthcare provider will bill your insurance company directly for reimbursement for the cost of the test, but clarifying this with your insurance provider can help you avoid surprise bills after your test.
|Centers for Disease Control and Prevention (CDC)||https://www.cdc.gov/coronavirus/2019-ncov/index.html||The CDC is the United States’ leading national public health organization. Its mission is to protect public health and safety through the control and prevention of disease, injury, and disability in the U.S. and abroad.|
|World Health Organization (WHO)||https://www.who.int/||A specialized agency of the United Nations, WHO is responsible for international public health. Headquartered in Geneva, Switzerland, it has field offices worldwide.|
|Association of Public Health Laboratories (APHL)||www.aphl.org||The APHL is a nonprofit organization in the United States that represents laboratories that protect public health and safety.|