In response to the COVID-19 Public Health Emergency, on January 10, 2022, the Biden-Harris Administration issued guidance requiring health insurance companies to cover the cost of over-the-counter (OTC) at-home COVID-19 tests for their members. Healthfirst complied with that guidance: coverage began on January 15, 2022. The Public Health Emergency expired on May 11, 2023. Read below to learn what this means for you, a Healthfirst member. If you’re not sure which health plan you are in, check the front of your Healthfirst Member ID card.
Healthfirst does not cover the cost of over-the-counter (OTC) at-home COVID-19 tests for Leaf/Leaf Premier Members.
Over-the-counter (OTC) at-home COVID-19 tests will continue to be available for purchase at pharmacies. Healthfirst will not reimburse you for the cost of these tests.
Over-the-counter (OTC) at-home COVID-19 tests are no longer covered for Medicaid and Personal Wellness Plan members.
Coverage of COVID-19 testing will continue to be provided to eligible members when administered by a Healthfirst-contracted provider or performed by a clinical laboratory.
Healthfirst covers the cost of FDA-authorized over-the-counter (OTC) at-home COVID-19 tests for Essential Plans and Child Health Plus members. Members are covered for two test kits per week–up to 8 tests in a 30-day period (one kit may contain two tests). Make sure to keep your receipt. No prescription is needed. Only FDA-authorized OTC at-home COVID-19 tests are covered.
To get a covered test, visit a pharmacy in the Healthfirst pharmacy network. We understand that many pharmacies are short staffed and may not be able to process your request. If you are unable to get a test at the pharmacy counter, please purchase one at the retail counter and keep your receipt for reimbursement. You can request your reimbursement online through your Caremark.com account—there’s no need to mail anything in. To request reimbursement online, visit COVID-19 OTC | CVS Caremark and follow these instructions:
For help with reimbursement, call the Healthfirst Member Services number on your member ID card.
Medicare Fee-for-Service (“Original Medicare”) does not cover the cost of over-the-counter (OTC) at-home COVID-19 tests for Medicare plan members.
Members of Increased Benefits Plan and Signature (HMO) may use their OTC Plus or OTC card to purchase OTC at-home COVID-19 testing kits at participating retailers.
Medicare Fee-for-Service (“Original Medicare”) does not cover the cost of OTC at-home COVID-19 tests for CompleteCare and Life Improvement Plan members.
Medicaid Fee-for-Service (FFS) covers the cost of FDA-authorized at-home COVID-19 tests for CompleteCare and Life Improvement Plan members. Only FDA-authorized at-home COVID-19 tests are covered. Members are covered for two tests per week—up to eight tests in a 30-day period (one kit may contain two tests). No prescription is needed.
To get a covered FDA-authorized at-home COVID-19 test for free, visit a pharmacy in the NYRx Medicaid network. Search for a Pharmacy or Medical Equipment Supplier (emedny.org).
You can also use your OTC Plus card to purchase OTC at-home COVID-19 testing kits at participating retailers.
REMEMBER: Always call the pharmacy or participating retailer first to make sure that they have the testing kits in stock.
Medicaid Fee-for-Service (FFS) covers the cost of FDA-authorized over-the-counter (OTC) at-home COVID-19 tests for Senior Health Partners members. Only FDA-authorized at-home COVID-19 tests are covered. Members are covered for two tests per week—up to eight tests in a 30-day period (one kit may contain two tests). No prescription is needed. For quantities greater than eight tests per month, you will need to present a prescription from a qualified healthcare provider.
Using your New York State (NYS) Medicaid benefits, you may pick up a COVID-19 at-home test at any pharmacy that accepts your NYS Medicaid benefit card. Please note that supplies may be limited in many areas, and this benefit is subject to availability. Always call the pharmacy first to make sure that they have tests in stock. If you have questions, call the Medicaid Helpline at 1-800-541-2831, Monday to Friday, 8am‒8pm, and Saturday, 9am‒1pm.
Coverage is provided by Healthfirst Health Plan, Inc., Healthfirst PHSP, Inc., and/or Healthfirst Insurance Company, Inc. (together, “Healthfirst”). Coverage for Senior Health Partners, Managed Long-Term Care Plan, is provided by Healthfirst PHSP, Inc.
Healthfirst complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
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