This post was updated to reflect recent changes in government and insurers’ policies to help patients seeking either COVID-19 viral testing or COVID-19 antibody testing. Please check regularly for updates. Last revised on March 30, 2023.
We believe it’s important that patients have all the information. So, we’re breaking down how COVID-19 viral and antibody testing is being covered. Keep in mind that policies regarding your out-of-pocket costs for coronavirus testing and treatment are changing rapidly. We’re here to make sure you have all the necessary information and provide timely updates as they pertain to COVID-19 testing.
Is testing free if I have insurance?
A clinic visit to get a COVID-19 test typically has three parts: (1) The co-pay for the office visit, (2) the cost of the office visit, (3) the cost of the COVID-19 test.
Co-Pays
You will be charged your regular copay.
Office Visits
During your office visit, if you are symptomatic or at risk, additional tests and evaluations such as a flu test may be performed in the clinic. Different insurance providers deal with these in different ways. Sometimes they make you pay toward your deductible for these. In these cases, you may get a bill from MainStreet for aspects of the office visit that were not the COVID-19 test.
The COVID-19 Test
We are now offering a COVID-19 rapid swab test which will be performed in the clinic. COVID-19 antibody blood tests and COVID-19 molecular swab tests will be sent out to a lab company to be tested. MainStreet will bill your insurance for the COVID-19 rapid swab test, and the lab company will bill the insurance company for the COVID-19 antibody test or COVID-19 PCR test. Your insurance company (or Medicare / Medicaid) will then tell us or the lab company if you owe anything. Both the viral swab test and the blood antibody test should be covered by your insurance provider.
So, why might you still get a bill from the lab company or from MainStreet? Some labs are set up to ‘bundle’ tests into a panel of tests due to device configuration or other tests needed for a full understanding of your situation. In both of these cases, you may get a bill from the lab company for the tests beyond the COVID-19 test.
The summary is that a COVID-19 test itself should be at no charge to you if you have insurance. However, in order to get the test, other services may be performed that the insurance company wants you to pay for.
How do I know if I’m going to end up with a bill?
The best first step is to call your insurance company and understand your deductible and their policy for COVID-19 testing. The COVID-19 test itself should be at no charge to you. However, there are other services consumed in the course of getting a COVID test and these CAN generate bills for you.
If you receive a bill, you are to contact your insurance company. While we are waiving your up-front costs, it’s possible your insurance may still leave a balance to you upon processing the visit. If this is the case and you have questions, please contact your insurance carrier.
What if I have health insurance, but my plan has a high deductible?
The higher the deductible your health plan has, the more likely some aspect of getting a COVID-19 test will result in your insurance company saying you need to pay for some step in getting a test. While the test itself is covered, the insurance company may find other ways to require that you be billed.
Under the legislation recently passed by Congress, testing for the coronavirus is free. The costs of your visit to MainStreet to get tested should be covered as well. States are concerned that patients will hesitate because of the potential bills, so states are working with insurance companies to regulate the coverage of testing costs. In turn, these insurance companies are working with labs to waive any costs associated with the actual test.
Is testing free if I have Medicaid?
We do accept Medicaid, Medicaid Managed Care Plans and AllKids insurance. For more information on how Medicaid is covering COVID-19 testing please visit your state’s Medicaid website listed at the bottom of this page.
Is testing free if I have Medicare?
We do accept Medicare insurance. For more information on how Medicare is covering COVID-19 testing please visit Medicare’s website.
Is my test covered if I am a Veteran?
We do accept Tricare insurance. For more information on how Tricare is covering COVID-19 testing please visit Tricare’s website.
If I need to be retested for COVID-19, will my insurance cover it?
Congress has ordered insurance companies to cover COVID-19 testing and treatment. However, it is unclear if insurance will cover subsequent testing. Other services may also be performed that the insurance company wants you to pay for. The best course of action is to contact your insurance company regarding your policy and COVID-19. We’ve provided links to the insurance companies we accept at the bottom of this page.
If you don’t have insurance, please read below.
How much is COVID-19 testing if I don’t have insurance?
The Department of Human Health Services Uninsured Patient Program is no longer available at MainStreet Family Care. Uninsured patients will be charged our Simple Self-Pay price of $129. This covers anything we can do for you in-clinic including the COVID-19 rapid antigen test. This does not cover the cost of a PCR test or antibody test, which is sent out to LabCorp. LabCorp will bill separately for the cost of these tests.
Where do I go to find the most updated information for my needs?
Below you can find information on your insurance company’s information as it pertains to COVID-19 testing. We accept most major insurance plans. However, it is the patient’s responsibility to bring along a valid government-issued ID with them to each visit. Subsequently, we require that all patients have a valid, non-expired ID present in order to be seen by a provider.
