Healthfirst’s Over-the-Counter At-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) at-home COVID-19 tests for their members.* Healthfirst is complying with that guidance: coverage began on January 15, 2022. 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.

*Recent changes in New York State regulatory guidance also impact coverage of OTC at-home COVID-19 tests.

Leaf & Leaf Premier Plans

What is covered

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

Only FDA-authorized OTC 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.

Where to get the tests

To get a covered test for free, visit a pharmacy in the Healthfirst pharmacy network. If you pay for a test out-of-pocket, keep your receipt to submit it for reimbursement.

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:

  1. Sign in or register at Caremark.com
  2. Upload your proof of purchase; this can be a digital receipt or a photo of a paper receipt.

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. You will receive reimbursement approximately 30 days from receipt of your out-of-pocket payment documentation. For help with reimbursement, 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.

EPO Plans/Individual (Total) and Small Business

What is covered

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

Only FDA-authorized OTC 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.

Where to get the tests

To get a covered test for free, visit a pharmacy in the Healthfirst pharmacy network. If you pay for a test out-of-pocket, keep your receipt to submit it for reimbursement.

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:

  1. Sign in or register at Caremark.com
  2. Upload your proof of purchase; this can be a digital receipt or a photo of a paper receipt.

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. You will receive reimbursement approximately 30 days from receipt of your out-of-pocket payment documentation. For help with reimbursement, 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.

Medicaid and Personal Wellness Plan (PWP)

What is covered

As of December 13, 2021, Healthfirst covers the cost of certain FDA-authorized over-the-counter (OTC) at-home COVID-19 tests for Medicaid and Personal Wellness Plan (PWP) members.

Only FDA-authorized OTC 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.

Where to get the tests

To get a covered test for free, visit a pharmacy in the Healthfirst pharmacy network.

For help getting covered tests, Medicaid members should call Healthfirst Member Services at 1-866-463-6743 (TTY 1-888-542-3821), Monday to Friday, 8am‒6pm; PWP members should call 1-855-659-5971 (TTY 1-888-542-3821), 7 days a week, 24 hours a day.

REMEMBER: Always call the pharmacy first to make sure that they have the tests in stock.

Essential Plans

What is covered

As of January 3, 2022, Healthfirst covers the cost of FDA-authorized over-the-counter (OTC) at-home COVID-19 tests for Essential Plan members. Members are covered for two test kits per week–up to 16 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.

Where to get the tests

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 will receive reimbursement approximately 30 days from receipt of your out-of-pocket payment documentation. 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:

  1. Sign in or register at Caremark.com
  2. Upload your proof of purchase; this can be a digital receipt or a photo of a paper receipt.

For help with reimbursement, Essential Plan members should call Healthfirst Member Services at 1-888-250-2220 (TTY 1-888-542-3821), Monday to Friday, 8am‒6pm.

Child Health Plus (CHP)

What is covered

As of January 3, 2022, Healthfirst covers the cost of FDA-authorized over-the-counter (OTC) at-home COVID-19 tests for CHP members. Members are covered for two test kits per week–up to 16 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.

Where to get the tests

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 will receive reimbursement approximately 30 days from receipt of your out-of-pocket payment documentation. 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:

  1. Sign in or register at Caremark.com
  2. Upload your proof of purchase; this can be a digital receipt or a photo of a paper receipt.

For help with reimbursement, CHP members should call Healthfirst Member Services at 1-866-463-6743 (TTY 1-888-542-3821), Monday to Friday, 8am‒6pm.

Life Improvement Plan (HMO D-SNP)

What is covered

As of April 4, 2022, at-home COVID-19 tests are covered by Medicare Fee-for-Service (“Original Medicare”). You are covered for up to eight tests in a 30-day period (one kit may contain two tests). No prescription is needed. If you need more than eight tests per month, you will need to get a prescription from a qualified healthcare provider.

Only FDA-authorized OTC at-home COVID-19 tests are covered.

Where to get the tests

First, check with your pharmacy or healthcare provider to see if they are participating in the Medicare COVID-19 Over-the-Counter (OTC) tests initiative. If so, they can give you at-home tests and will bill Medicare for you (at no cost to you). To find a participating pharmacy, visit medicare.gov/medicare-coronavirus or call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. Be sure to bring your red, white, and blue Medicare card to get your free tests.

CompleteCare (HMO D-SNP)

What is covered

As of April 4, 2022, at-home COVID-19 tests are covered by Medicare Fee-for-Service (“Original Medicare”). You are covered for up to eight tests in a 30-day period (one kit may contain two tests). No prescription is needed. If you need more than eight tests per month, you will need to get a prescription from a qualified healthcare provider.

Only FDA-authorized OTC at-home COVID-19 tests are covered.

Where to get the tests

First, check with your pharmacy or healthcare provider to see if they are participating in the Medicare COVID-19 Over-the-Counter (OTC) tests initiative. If so, they can give you at-home tests and will bill Medicare for you (at no cost to you). To find a participating pharmacy, visit medicare.gov/medicare-coronavirus or call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. Be sure to bring your red, white, and blue Medicare card to get your free tests.

Signature (HMO)

What is covered

As of April 4, 2022, at-home COVID-19 tests are covered by Medicare Fee-for-Service (“Original Medicare”). You are covered for up to eight tests in a 30-day period (one kit may contain two tests). No prescription is needed. If you need more than eight tests per month, you will need to get a prescription from a qualified healthcare provider.

Only FDA-authorized OTC at-home COVID-19 tests are covered.

Where to get the tests

First, check with your pharmacy or healthcare provider to see if they are participating in the Medicare COVID-19 Over-the-Counter (OTC) tests initiative. If so, they can give you at-home tests and will bill Medicare for you (at no cost to you). To find a participating pharmacy, visit medicare.gov/medicare-coronavirus or call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. Be sure to bring your red, white, and blue Medicare card to get your free tests.

Increased Benefits Plan (HMO)

What is covered

As of April 4, 2022, at-home COVID-19 tests are covered by Medicare Fee-for-Service (“Original Medicare”). You are covered for up to eight tests in a 30-day period (one kit may contain two tests). No prescription is needed. If you need more than eight tests per month, you will need to get a prescription from a qualified healthcare provider.

Only FDA-authorized OTC at-home COVID-19 tests are covered.

Where to get the tests

First, check with your pharmacy or healthcare provider to see if they are participating in the Medicare COVID-19 Over-the-Counter (OTC) tests initiative. If so, they can give you at-home tests and will bill Medicare for you (at no cost to you). To find a participating pharmacy, visit medicare.gov/medicare-coronavirus or call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. Be sure to bring your red, white, and blue Medicare card to get your free tests.

Coordinated Benefits Plan (HMO)

What is covered

As of April 4, 2022, at-home COVID-19 tests are covered by Medicare Fee-for-Service (“Original Medicare”). You are covered for up to eight tests in a 30-day period (one kit may contain two tests). No prescription is needed. If you need more than eight tests per month, you will need to get a prescription from a qualified healthcare provider.

Only FDA-authorized OTC at-home COVID-19 tests are covered.

Where to get the tests

First, check with your pharmacy or healthcare provider to see if they are participating in the Medicare COVID-19 Over-the-Counter (OTC) tests initiative. If so, they can give you at-home tests and will bill Medicare for you (at no cost to you). To find a participating pharmacy, visit medicare.gov/medicare-coronavirus or call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. Be sure to bring your red, white, and blue Medicare card to get your free tests.

65 Plus Plan (HMO)

What is covered

As of April 4, 2022, at-home COVID-19 tests are covered by Medicare Fee-for-Service (“Original Medicare”). You are covered for up to eight tests in a 30-day period (one kit may contain two tests). No prescription is needed. If you need more than eight tests per month, you will need to get a prescription from a qualified healthcare provider.

Only FDA-authorized OTC at-home COVID-19 tests are covered.

Where to get the tests

First, check with your pharmacy or healthcare provider to see if they are participating in the Medicare COVID-19 Over-the-Counter (OTC) tests initiative. If so, they can give you at-home tests and will bill Medicare for you (at no cost to you). To find a participating pharmacy, visit medicare.gov/medicare-coronavirus or call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. Be sure to bring your red, white, and blue Medicare card to get your free tests.

Senior Health Partners

What is covered

As of January 10, 2022, 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.

Where to get the tests

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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