COVID-19 Testing

A female healthcare professional gives instructions to a male colleague as they work at a COVID drive through testing site.

COVID-19 Testing

COVID-19 testing is still important. Learn about when you need to get tested, what is covered, and convenient options for testing. Visit your city or state’s COVID-19 sites for information on testing locations in your area: New York CityNew York StateNew JerseyConnecticutPennsylvania. You can also find a community based testing site here.

If you have symptoms of coronavirus (COVID-19), call your doctor. Based on the details of your symptoms, your doctor will let you know whether it’s recommended that you get tested. If you are fully vaccinated, check the most up-to-date CDC guidance for information on testing. Talk to your doctor if you’re not sure.

If you go to an in-network doctor or provider to get tested for the coronavirus (COVID-19):

  • Your diagnostic test and in-person visit to diagnose COVID-19 will be covered by your plan. There will be no cost-sharing, including copays, coinsurance, or deductibles.
  • Beginning Jan. 3, 2022, COVID-19 tests for screening purposes (employment, return to work/school, travel etc…) for Essential Plan and Child Health Plus members only, will be covered. These “Point of Care” tests are performed in a doctor’s office, pharmacy, or facility. There will be no cost-sharing, including copays, coinsurance, or deductibles.
  • CVS Pharmacy Minute Clinic® offers no-cost COVID-19 testing by appointment throughout the region. Visit their COVID-19 testing page to schedule a test.
  • AdvantageCare Physicians takes care of the whole you, including testing for COVID-19. To learn more, visit ACPNY’s COVID-19 testing page.
  • Ready (also known as Ready Responders) offers no-cost, same-day, in-home rapid testing with trained health care professionals. If you feel sick or may have been exposed, they’ll send a Responder right to your home or preferred location where you feel safe. No waiting rooms, lines, or drive time. Book a test at getready.com.

    Ready offers testing in Manhattan, Brooklyn, Queens, the Bronx, Westchester, and Nassau Counties.*

    *Ready does not currently offer testing outside of these New York City boroughs. No-cost testing is in accordance with Federal and State waivers guidelines.

If you go to an out-of-network doctor or provider to get tested for the coronavirus (COVID-19):

  • Your diagnostic test and in-person visit to diagnose COVID-19 will be covered by your plan. This includes any doctors outside of our network. There will be no cost-sharing, including copays, coinsurance, or deductibles. Treatment should still be obtained at a facility in our network, unless it is an emergency. If you are admitted to a facility not in our network, your treatment may NOT be covered by your plan. All normal coverage restrictions and cost-sharing charges will apply for care or treatment, including inpatient hospital admissions. Some plans do not cover out-of-network services, so this could include the total cost for services.

If you go to the emergency room to be tested for COVID-19:

  • Your diagnostic test and visit to diagnose COVID-19 will be covered by your plan. There will be no cost-sharing, including copays, coinsurance, or deductibles. Services you get for an emergency room visit will always be covered, if you are admitted to the hospital.

Visit your city or state’s COVID-19 sites for information on testing locations in your area: New York City, New York State, New Jersey, Connecticut, Pennsylvania. You can also find a community based testing site here.

For most members, if your plan covers the COVID-19 at-home, rapid tests that you purchased at a store, pharmacy, or online, you’ll have to send in some information to be reimbursed. This includes a completed claim form and your receipt. We may send you an attestation to confirm that the test was for a covered purpose. If the test is covered, then you will be reimbursed for the test at cost*. Here’s instructions on how to fill out the claim form, and important terms and conditions.

Medicaid members can receive their allowed number of COVID-19 at-home, rapid tests with an order directly from a pharmacy in our network. You will pay no out-of-pocket costs and will not need to submit a claim for reimbursement to EmblemHealth. You can find a pharmacy in our network here.

*Reimbursement amount is subject to change without notice in accordance with applicable rules.

Because of federal and state rules, members who have different types of plans have different levels of coverage for COVID-19 at-home, rapid tests.  For example, FDA authorized COVID-19 at-home, rapid tests that Medicare members buy at a pharmacy or store without an order from a licensed health care professional are not covered by their plan.

At a minimum, covered at-home, rapid tests must be purchased over-the-counter and authorized by the FDA. Many brands sell test kits with more than one test in it. See the details below to understand if and when at-home, rapid tests are covered by your plan.

EmblemHealth Commercial (except Medicare) members:
As of January 15, 2022, EmblemHealth plans covers eight (8) diagnostic only COVID-19 at-home, rapid tests per member per month with no out-of-pocket costs, as long as the test is not for employment or other non-covered purposes, such as for return to work.

EmblemHealth Essential Plan members:
As of January 3, 2022, EmblemHealth covers two (2) COVID-19 at-home, rapid test kits per week with no out-of-pocket costs.  Test kits may include more than one test. 

EmblemHealth Medicaid members:
As of December 13, 2021, EmblemHealth covers one (1) COVID-19 at-home, rapid test kit per week with no out-of-pocket costs, as long as the test has been ordered by a Medicaid medical provider.  Your provider can write you an order for the test kits you need. Bring your order directly to a pharmacy to receive your test(s). You can find a pharmacy in our network here. Child Health Plus (CHP) members are eligible for up to two (2) COVID-19 at-home rapid test kits per week. Test kits may include more than one test.

EmblemHealth Medicare Members:
All Original Medicare and Medicare Advantage members are not eligible for reimbursement for over-the-counter COVID-19 at-home rapid test kits. FDA authorized over-the-counter COVID-19 at-home, rapid tests that you buy at a pharmacy or store without a prescription or order from a licensed health care professional are not covered by your plan.

 

You can buy FDA authorized COVID-19 at-home, rapid tests at pharmacies, retail locations, or online. The Omicron variant has created a high demand for tests in many areas. Supplies may be limited.

To help address this, the federal government is expanding access to free, at-home kits. Residential households in the U.S. can now order one set of 4 free at-home tests here. They will begin shipping at the end of January 2022. 

For most members, testing for return to work or school, travel, or other recreational activities is not covered by your plan. EmblemHealth continues to cover medically appropriate FDA-authorized COVID-19 tests if your doctor thinks you may have COVID-19 or you were exposed to COVID-19 and orders the test. You will not have any cost-sharing, including copays, coinsurance, or deductibles for covered tests. If you’re not sure if your test will be covered, call us at the number on the back of your ID card. 

Beginning Jan. 3, 2022, COVID-19 tests for screening purposes (i.e., employment, return to work/school, travel etc…) for Essential Plan and Child Health Plus members only, will be covered. These “Point of Care” tests are performed in a doctor’s office, pharmacy, or facility. There will be no cost-sharing, including copays, coinsurance, or deductibles.

Get tested when and where you need it. We’ve worked with Ready (also known as Ready Responders) to offer no-cost, same-day, in-home rapid testing with trained health care professionals. If you feel sick or may have been exposed, they’ll send a Responder right to your home or preferred location where you feel safe. No waiting rooms, lines, or drive time.

Ready offers testing in Manhattan, Brooklyn, Queens, the Bronx, Westchester, and Nassau Counties. Your rapid test won’t cost you anything, and you’ll never receive a bill from Ready.*


Book a test at getready.com or call 504-370-9966. Their hours are 8 a.m. to 8 p.m., seven days a week (including holidays). Have your ID and insurance information ready.


*Ready does not currently offer testing outside of these New York City boroughs. No-cost testing is in accordance with Federal and State waivers guidelines.

If your doctor or licensed health care professional sends you to get your antibodies checked for COVID-19 because it is clinically indicated, your visit and FDA-authorized test will be covered. There will be no cost-sharing, including copays, coinsurance, or deductibles.

We encourage our members to use Quest Diagnostics for their testing. Quest is EmblemHealth’s in-network, preferred lab and testing provider.

Antibody testing for return to work or school, travel, or other recreational activities is not covered by your plan. EmblemHealth only covers non-diagnostic antibody tests when these services are delivered according to the terms of your benefit plan. If you’re not sure if your test will be covered, call us at the number on the back of your ID card.