What you should expect to pay for a COVID-19 diagnostic test, if anything

Executive Summary

• Your health insurance should cover the cost of COVID-19 testing and any related services, but an out-of-network provider or lab could be charging your insurer higher than usual fees
• If you’re uninsured, there may be state (Medicaid) or commercial (brand awareness) entities that are offering free tests, otherwise you have to pay the cash price
• A COVID-19 diagnostic test that costs $100 is a reasonable rate (as of 2021, Medicare pays this amount for a test result within two days, otherwise $75). The rates are different for antigen and antibody tests.
• More affordable ($30) and convenient options (results via app), such as at-home kits are forthcoming

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If you’ve been watching traditional news on television or the internet, my bet is that you were told that COVID-19 tests are free. That is true for the most part because the Families First Coronavirus Response Act (passed on March 18, 2020) stipulates that all COVID-19 testing should have no cost-sharing, including deductibles, co-insurance and co-pay for the duration of the COVID-19 public health emergency (since January 27, 2020 and last renewed for another 90 days on January 21, 2021). Costs include the vaccination, administration and any related services and is relevant to private insurance, Medicare, Medicaid and other government programs, for defense, veterans and Native Americans. Medicaid may choose to cover uninsured individuals (receiving reimbursement via 100% Federal Medical Assistance Percentage).

The CARES Act passed on March 27, 2020 further stipulates the all COVID-19 diagnostics tests must be covered as long as they have been or intend to undergo review for emergency authorization use or is authorized directly by the Department of Health and Human Services. Private health plans would reimburse the negotiated rate, if not negotiate one or pay the cash price listed publicly on the website (a provider can face penalties for not listing the cash price). The tests will also be covered as preventative services within fifteen days and not the customary one year based on the recommendations of the authority bodies (USPTF or ACIP).

The Peterson-KFF (Kaiser Family Foundation) Health System Tracker (published July 15, 2020) found cases where patients do end up with bills or health insurers paying much higher prices than usual for both diagnostic and antibody tests (CDC references for the difference between these two types tests). The Advisory Board published a brief on June 17, 2020 that conveys how providers or labs for COVID-19 diagnostic testing are taking advantage of out-of-network cash prices that are well above the Medicare reimbursement rate of $100. They both point out that higher costs paid by the insurer can lead to higher future premiums to the detriment of the consumer.

More recently, Bloomberg (published on December 15, 2020) mentioned how the FDA approved an at-home test that could cost $30. After returning to the lab, it takes fifteen minutes to deliver results via an app. The mechanism for testing is a nasal swab and could be less accurate – it detects proteins on the virus’ surface (antigen), not the virus’ genetic makeup (diagnostic).