Healthfirst’s Over-the-Counter In-Home COVID-19 Testing Coverage

On January 10, 2022, the Biden-Harris Administration issued guidance requiring health insurance companies to cover the cost of over-the-counter (OTC) in-home COVID-19 tests for their members. Healthfirst is complying with that guidance: coverage begins on January 15, 2022. Read below to learn what this means for you, a Healthfirst member.

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Leaf & Leaf Premier Plans and EPO Plans

As of January 15, 2022, Healthfirst covers the cost of over-the-counter (OTC) in-home COVID-19 tests for Leaf & Leaf Premier Plan and EPO Plan members.

What is covered

All FDA-authorized OTC in-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.

Where to get the tests

Pharmacies: To get a covered test, visit a pharmacy in the Healthfirst pharmacy network. Keep your receipt to submit for reimbursement (up to $12 per individual test).

We understand that many pharmacies are short staffed and may not be able to process your request. If you are unable to obtain a test at the pharmacy counter, please purchase one at the retail counter and keep your receipt for reimbursement (up to $12 per individual test).

If you get a covered test at a pharmacy that is not in the Healthfirst pharmacy network, Healthfirst will reimburse you up to $12 per individual test. Make sure to keep your receipt. The reimbursement process is still in development. If you have any questions, call Healthfirst Member Services at 1-866-463-6743 (TTY 1-888-542-3821), Monday to Friday, 8am‒6pm. REMEMBER: Always call the pharmacy first to make sure that they have the tests in stock.

Online: You can order OTC in-home COVID-19 tests with free delivery from the online pharmacy, Capsule. Visit their Essentials store in their app (iOS | Android) or visit the Capsule website.

By phone: Call or text us at 1-212-675-3900 to order OTC in-home COVID-19 tests.

Medicaid, Personal Wellness Plan (PWP), and Child Health Plus (CHP)

As of December 13, 2021, Healthfirst covers the cost of certain FDA-authorized over-the-counter (OTC) in-home COVID-19 tests for Medicaid, Personal Wellness Plan (PWP), and Child Health Plus (CHP) members. Members are covered for two tests per week—up to eight tests in a 30-day period (one kit may contain two tests). A prescription from a healthcare professional is needed for each test kit.

What is covered

The following OTC in-home COVID-19 tests are covered*:

  • BinaxNOW COVID-19 Antigen Rapid Self-Test
  • CareStart COVID-19 Antigen Home Test
  • InteliSwab COVID-19 Rapid Test
  • QuickVue® At-Home OTC COVID-19 Test

*List may change as new tests receive FDA authorization.

Where to get the tests

Pharmacies: To get a covered test, visit a pharmacy in the Healthfirst COVID-19 Vaccine Pharmacy Network.

We understand that many pharmacies are short staffed and may not be able to process your request. If you are unable to obtain a test at the pharmacy counter, please purchase one at the retail counter and keep your receipt for reimbursement.

If you get a covered test at a pharmacy that is not in the Healthfirst COVID-19 Vaccine Pharmacy Network, Healthfirst will reimburse you. Make sure to keep your receipt.

For help with reimbursement, call Healthfirst Member Services at 1-866-463-6743 (TTY 1-888-542-3821), Monday to Friday, 8am‒6pm, for Medicaid; and 1-855-659-5971 (TTY 1-888-542-3821), 7 days a week, 24 hours a day, for PWP. REMEMBER: Always call the pharmacy first to make sure that they have the tests in stock.

By phone: Call or text us at 1-212-675-3900 to order OTC in-home COVID-19 tests.

Essential Plans

As of January 3, 2022, Healthfirst covers the cost of FDA-authorized over-the-counter (OTC) in-home COVID-19 tests for Essential Plan members. Members are covered for two test kits per week (one kit may contain two tests). Make sure to keep your receipt.

We understand that many pharmacies are short staffed and may not be able to process your request. If you are unable to obtain a test at the pharmacy counter, please purchase one at the retail counter and keep your receipt for reimbursement.

The reimbursement process is still in development. If you have any questions, call Member Services at 1-888-250-2220 (TTY 1-888-542-3821), Monday to Friday, 8am‒6pm. Check back here for updates.

Medicare Advantage Plans

Information coming soon! Check back here or call Member Services at 1-888-260-1010 (TTY 1-888-542-3821), 7 days a week, 8am–8pm (October through March), and Monday to Friday, 8am–8pm (April through September).

Senior Health Partners and CompleteCare Plans

As of December 13, 2021, Medicaid Fee-for-Service (FFS) covers the cost of certain FDA-authorized over-the-counter (OTC) in-home COVID-19 tests for Senior Health Partners and CompleteCare members. Members are covered for one test kit per fiscal order (each kit may contain two tests for serial testing), with no refills, and can order test kits with a limit of one per week.

What is covered

The following OTC in-home COVID-19 tests are covered*:

  • BinaxNOW COVID-19 Antigen Rapid Self-Test
  • CareStart COVID-19 Antigen Home Test
  • InteliSwab COVID-19 Rapid Test
  • QuickVue® At-Home OTC COVID-19 Test

*List may change as new tests receive FDA authorization.

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”).

Healthfirst complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-866-305-0408 (TTY 1-888-867-4132).

注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電1-866-305-0408

(TTY 1-888-542-3821)。

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