information iconCoverage for at-home
COVID-19 tests

Updated on May 13, 2022

Fallon Health is covering over-the-counter COVID-19 tests for all Fallon members whose plan includes a pharmacy benefit. Please note that Fallon Health also covers medically necessary PCR and antigen tests at no cost.   

For Community Care, Direct Care, Select Care, and Preferred Care members with pharmacy benefits

Where to get test kits

You can get FDA-authorized COVID-19 test kits at Kinney Drugs, Sam's Club, Walgreens, Walmart and RiteAid at no cost to you. You will not need to submit a reimbursement form. Just go to the pharmacy counter, present your Fallon Health ID card and ask to have the product submitted to OptumRx. Coverage includes at-home COVID-19 test kits authorized by the Food and Drug Administration (FDA).The most common tests are BinaxNOW™, CLINITEST®, Flowflex™, i-Health®, InteliSwab™, On/Go™, QuickVue® and At-home test kits (Roche).

If you do not use one of the pharmacies listed above, keep your receipts and the name of your at-home test kit(s). You’ll need that information to submit a request for reimbursement.   

How to get reimbursed for test kits

If you purchase an FDA-authorized over-the-counter COVID-19 test kit at other stores or online retailers, or if you paid out-of-pocket for a test kit on or after January 15, you can submit a request for reimbursement. You will be reimbursed for up to 8 tests per covered member, per month at up to $12 per test.

Please submit your claim within one year of your purchase date. Reimbursement will be available through the end of the emergency health period.

Or, order a test kit online through Optum at no cost

If you order test kits online through the Optum store, you will not have to pay any upfront cost. You will also get free shipping on orders that would equal $45 or more. You will need to go to optumrx.com and sign in to your account. You may need to create a new account if you do not already have one. Then, go to “Get at home COVID-19 tests with $0 copay,” then click on the “order now” link.

For members of NaviCare, Berkshire Fallon Health Collaborative, Fallon 365 Care, Wellforce Care Plan, and Summit ElderCare

We will cover the cost of up to eight over-the-counter FDA-emergency use authorized tests per member per month. If you need more tests, you'll need a prior authorization. Prior authorization requests will be reviewed by Fallon Health on a case-by-case basis.

Where to get test kits

You can get one of the FDA-authorized COVID-19 test kits below at any network pharmacy at no cost to you. Just go to the pharmacy counter, show your member ID card, and ask to have the product submitted to OptumRx.

  • BinaxNOW™
  • Flowflex™
  • i-Health®
  • InteliSwab™
  • QuickVue® At-home

How to get reimbursed for test kits

You cannot get reimbursed for tests that you have paid for out-of-pocket. The only way that you can access covered tests at no cost to you is by getting one of the approved tests (see above) at any network pharmacy. You will need to go to the pharmacy counter, show your Fallon Health ID card and ask to have the product submitted to OptumRx.

Medicare is also covering test kits

People with Medicare Part B can get up to eight free over-the-counter tests each month. If you have a Medicare card, bring it to any pharmacy or health care provider that participates in this initiative. Check with your pharmacy or health care provider to see if they are participating (for a partial list visit https://www.medicare.gov/medicare-coronavirus. Coverage through Medicare will continue until the COVID-19 public health emergency ends. 

For Fallon Medicare Plus members with pharmacy benefits

The Federal government recently announced that they will cover up to eight free over-the-counter tests each month for people with Medicare Part B. You can bring your Medicare card to any pharmacy or health care provider that participates in this initiative (for a partial list, visit https://www.medicare.gov/medicare-coronavirus). Coverage through Medicare will continue until the COVID-19 public health emergency ends.

Fallon Health will also cover the cost of up to eight over-the-counter FDA-emergency use authorized tests per member per month without prior authorization. When you get FDA-authorized COVID-19 antigen test kits at a network pharmacy, there is zero cost to you as long as you go to the pharmacy counter, present your member ID card and ask to have the product submitted to OptumRx. If you purchase tests and submit your receipt for reimbursement, you may be reimbursed only at the pharmacy’s negotiated rate depending on your plan. So, you may not receive the full reimbursement for what you initially paid out of pocket.


Where to get test kits

You can get one of the FDA-authorized COVID-19 test kits below at any network pharmacy at no cost to you. Just go to the pharmacy counter, show your member ID card, and ask to have the product submitted to OptumRx. You can also order test kits online, but you will be responsible for paying shipping charges and you will need to submit for reimbursement for the costs of the tests. If you purchase tests and submit your receipt for reimbursement, you may be reimbursed only at the pharmacy’s negotiated rate depending on your plan. So, you may not receive the full reimbursement for what you initially paid out of pocket.

Coverage includes at-home COVID-19 antigen test kits authorized by the Food and Drug Administration (FDA). The most common tests are brands BinaxNOW™, CLINITEST®, Flowflex™, i-Health®, InteliSwab™, On/Go™, QuickVue® and At-home test kits (Roche). 

How to get reimbursed for test kits

If you purchase an FDA-authorized over-the-counter COVID-19 test kit at other stores or online retailers, or if you paid out-of-pocket for a test kit on or after January 15, you can submit a request for reimbursement. You may be reimbursed only at the pharmacy’s negotiated rate depending on your plan. So, you may not receive the full reimbursement for what you initially paid out of pocket.

Please submit your claim within one year of your purchase date. Reimbursement will be available through the end of the emergency health period.