An Official Pennsylvania Government Website
Translate
Begin Main Content Area

Testing Insurance Coverage

Before Getting Tested, Ask:

  • Is this an emergency?
    • If you feel sick and believe you have an emergency, call your doctor and seek medical care.  If you do not have a provider, call your local health department or 1-877-PA-HEALTH.
  • Who should get tested?
  • What will a test cost?
    •
  • Where can I get a test?

Know Your Coverage

Before you get tested for COVID-19, you need to understand what kind of health care coverage you have. The laws and regulations that govern health care coverage can impact different types of coverage in different ways.

Most people get health care coverage in one of the below ways. If you do not believe you fit into any of these categories or are not sure which category you fall in, call the Pennsylvania Insurance Department at 1-877-881-6388, and we can help you figure out which type of health care coverage you have. View more information about coverage for testing.

 I have symptoms or a recent exposure. 

  • If you are covered by Medicare or Medicare Advantage: Medicare covers the lab tests for COVID-19 with no out-of-pocket costs and the deductible does not apply when the test is ordered by your doctor or other health care provider. 

  • If you are covered by Medical Assistance or CHIP: All lab tests, including tests for COVID-19, are covered without copayments or prior authorization.

  • If you have health care coverage directly from an insurance company, the health insurance marketplace, or through your employer (including through COBRA): A test must be covered if your attending health care provider has assessed your individual situation and determined that it is medically appropriate (you have symptoms or have a known or likely recent exposure to COVID-19).

    Contact your insurance company to make sure your lab is in-network or check to see what provisions the insurer has put in place for out-of-network lab work. Hospitals and providers are expected to bill insurance companies for the fees associated with collecting the specimens, and labs are expected to bill insurance companies for the actual testing.

    If the test is recommended by your doctor or other health care provider, the Families First Coronavirus Response Act and CARES Act require coverage for the order for and administration of the test with no cost-sharing and no prior authorization or other medical management requirements for provider visits (office, urgent care, Emergency Room) that result in an order for or administration of a COVID-19 test.

  • If you have coverage through the Pennsylvania Employee Benefit Trust Fund (PEBTF): PEBTF/Retired Employees Health Program (REHP) medical plans will waive all deductibles, coinsurance and copays for diagnostic testing and in-network inpatient hospital care, emergency room or urgent care for COVID-19. The policy will cover the test kit for members who meet Centers for Disease Control and Prevention (CDC) guidelines for testing in any approved laboratory location. 


 I have no symptoms or recent exposure.  

  • If covered by Medicare and Medicare Advantage: If the test is recommended by an attending health care provider, the Families First Coronavirus Response Act requires coverage for the order of and administration of the test with no cost-sharing and no prior authorization. If you are without symptoms (or asymptomatic), testing is covered for residents and patients of nursing homes.

  • If covered by Medical Assistance or CHIP:  If the test is recommended by an attending health care provider and the provider writes an order for the test, the Families First Coronavirus Response Act requires coverage for the order of and administration of the test with no cost-sharing and no prior authorization. 

  • If you have health care coverage directly from an insurance company, the health insurance marketplace, or through your employer (including through COBRA): Check with your insurance company.  Often, a patient authorization phone number is listed on the back of your health insurance card. The Families First Coronavirus Response Act and CARES Act do not require an insurance company to pay for a test unless you have symptoms or a known or recent exposure to COVID-19 and it has been determined to be medically necessary for you by an attending healthcare provider. 

  • If you have coverage through the Pennsylvania Employee Benefit Trust Fund (PEBTF):  Tests must be covered when there has been known or recent exposure to COVID-19 and it has been determined to be medically necessary by an attending health care provider.

​



Expand AllClick here for a more accessible version

Common Questions

Get the answers to frequently asked testing coverage questions below.

​