Coverage for over-the-counter at home COVID tests under HealthSelectSM Medicare Rx
PLEASE NOTE: The following information applies only to health plan participants who are enrolled in Medicare and have prescription drug coverage through HealthSelectSM MedicareRx. If you are not enrolled in Medicare and have prescription drug coverage through HealthSelectSM Prescription Drug Program, visit the Coverage for over-the-counter at home COVID tests under HealthSelectSM Prescription Drug Program page or on the OptumRx website.
The following information applies to certain at-home COVID-19 tests (details below) for participants enrolled in HealthSelectSM MedicareRx offered through the Employees Retirement System of Texas (ERS).
Getting tests at in-network retailers
The tests will be covered under your pharmacy benefit. To get these tests at no out-of-pocket cost to you, you must use your prescription insurance card at a preferred in-network pharmacy. You don’t need a prescription for these tests at the covered limit. Just go to the pharmacy counter at any Rite Aid (including Bartell Drugs), Sam’s Club, Walgreens (including Duane Reade) or Walmart and present your prescription insurance card along with the tests you are purchasing. The list of pharmacies is subject to change. To get the latest list of preferred in-network pharmacies, please call UnitedHealthcare customer service toll-free at (866) 868-0609 (TTY: 711), 7 a.m. – 7 p.m. CT, Monday through Friday, 7 a.m. – 3 p.m. CT on Saturday.
Getting tests from out-of-network retailers
If you buy a test from a retailer—either online or in person—that is not providing OTC at-home COVID-19 tests as part of the UnitedHealthcare preferred pharmacy network, you are responsible for paying the total cost out of pocket and seeking direct reimbursement from HealthSelect MedicareRx. HealthSelect will reimburse you up to $12 for each test (not each box). To submit an online reimbursement request, please complete the COVID-19 Over-the-Counter Test Reimbursement Form and attach a copy of your receipt. You can find a printable version of the COVID-19 Over-the-Counter Test Reimbursement Form on the OptumRx website. You can print and mail the completed form, along with the purchase receipt(s) to:
OptumRx Claims Department
P.O. Box 650334
Dallas, TX 75265-0334
Helpful notes for submitting claims:
- Enter the ID number on your prescription insurance card, not your medical insurance card.
- You can submit your claim now for COVID-19 test kits purchased on or after January 15.
- Submit your claim within one year of your purchase date.
- Coverage allows for up to eight tests per plan participant per calendar month. For example, if your HealthSelect coverage includes yourself, your spouse and three children, each calendar month, your household can get up to 40 tests—eight tests for each person participating in the plan—at no cost to you.
- Under federal guidelines, the plan covers only specific tests. Please call UnitedHealthcare customer service toll-free at (866) 868-0609 (TTY:711) or see the "COVID-19 at home test kits FAQs" under Which COVID-19 test kits are covered for the most up to date list of covered tests. The list will be updated as new FDA-authorized or approved tests become available.
- Some OTC at-home COVID-19 test kit packages contain more than one test. Your covered calendar-month limit is based on the number of tests, not the number of boxes.
- For example, if you have individual coverage and purchase boxes that contain two tests in each box, your insurance will cover four boxes (with a total of eight tests) in a calendar month.
- If you buy a test from a retailer – either online or in person – that is not providing OTC at-home COVID-19 tests as part of the UnitedHealthcare preferred pharmacy network or without your prescription ID card, you are responsible for paying the total cost out of pocket and seeking direct reimbursement from the HealthSelect MedicareRx. The online and mail-in reimbursement processes are detailed above.
- If you submit for direct reimbursement, your coverage is still limited to the approved tests listed in the "COVID-19 at home test kits FAQs" under Which COVID-19 test kits are covered?, up to eight tests per insured participant each calendar month.
- If you submit for direct reimbursement (with a purchase receipt), you are eligible for payment of up to $12 for each test (not each box).
- Your medical benefits will continue to cover other clinician-administered COVID-19 tests, such as PCR tests at doctors’ offices and other testing sites.
You can find more information about your coverage and reimbursement for OTC at-home COVID-19 tests by signing in to your account on HealthSelect MedicareRx plan website. The Centers for Medicare and Medicaid Services (CMS) website has information on general access to OTC at-home COVID-19 tests. Anyone may order OTC at-home COVID-19 tests at no cost to them from the federal government by visiting www.covidtests.gov.