Medicare covers COVID-19 tests at no cost to you

Medicare Part B pays for COVID-19 tests ordered by your doctor, with no copay, coinsurance, or deductible. This applies whether you get a test at a hospital, urgent care clinic, doctor's office, or pharmacy. You do not pay anything out of pocket for the test itself — Medicare sends payment directly to the provider.

The coverage includes three types of tests: molecular tests (also called PCR or nucleic acid tests), antigen tests, and antibody tests. All three are covered the same way. The test must be ordered by a doctor, nurse practitioner, or physician assistant — you cannot straightforward walk in and have Medicare pay for a test you order yourself.

This policy has been in place since the start of the pandemic and remains current. However, the rules around what counts as "ordered by a provider" have shifted over time, so it is worth understanding exactly what Medicare will and will not cover right now.

Key Takeaways

  • Medicare Part B covers COVID-19 tests with zero cost to you when a doctor, nurse practitioner, or physician assistant orders the test.
  • The test must be done at a Medicare-approved location such as a hospital, clinic, doctor's office, or participating pharmacy.
  • At-home tests you buy yourself and use without a provider's order are not covered by Medicare, even if you later show the result to your doctor.
  • If you have Medicare Advantage (Part C), your plan must cover COVID-19 tests the same way Original Medicare does, but you should check your plan documents or call your plan to confirm.
  • You will need to show your Medicare card when you arrive for the test so the provider can bill Medicare directly.

Where you can get a covered COVID-19 test

Any location that is enrolled as a Medicare provider can bill Medicare for a COVID-19 test. This includes doctor's offices, hospital outpatient departments, urgent care clinics, federally may have access to health centers, and many pharmacies. Walgreens, CVS, and Rite Aid all participate in Medicare, as do most independent pharmacies.

When you call to schedule a test, tell the staff you have Medicare and ask whether they bill Medicare directly for COVID-19 tests. Most will say yes. If a location says they do not accept Medicare for this service, you can go elsewhere — you have many options in most areas.

Some locations may ask you to pay upfront and then submit a claim to Medicare yourself. This is not standard practice, but if it happens, ask the provider to bill Medicare directly instead. If they refuse, you can file the claim yourself by calling Medicare at 1-800-MEDICARE or going to Medicare.gov.

What "ordered by a provider" means now

Medicare requires that a doctor, nurse practitioner, or physician assistant order your test. In the early pandemic, this meant a phone call or in-person visit. Now, many providers allow you to request a test through their patient portal, by email, or by phone without a full appointment — and Medicare will still cover it.

The key is that a licensed provider must make the decision that you need a test. You cannot straightforward buy an at-home test kit from a drugstore, use it yourself, and then ask Medicare to pay. Even if you later show the positive result to your doctor, the test was not ordered by them, so Medicare will not cover it.

If you have symptoms or have been exposed to COVID-19 and want a test, contact your doctor's office, an urgent care clinic, or a pharmacy that offers testing. Tell them you have Medicare. They will either order the test on the spot or ask you a few questions to decide whether testing is needed.

Medicare Advantage plans and COVID-19 tests

If you have Medicare Advantage (Part C) instead of Original Medicare, your plan must cover COVID-19 tests with no cost to you — the same as Original Medicare does. However, your plan may have a network of preferred providers, and you may save money by using those providers.

Call your Medicare Advantage plan before you get a test and ask which locations they prefer. Some plans may require you to use in-network providers, though most will still cover out-of-network tests. Your plan documents or member handbook will spell out the details, or you can call the customer service number on your insurance card.

What happens if you pay out of pocket

If you pay for a COVID-19 test yourself — either because you bought an at-home test or because a provider did not bill Medicare — you generally cannot get Medicare to reimburse you later. Medicare will not pay for tests that were not ordered by a provider at the time the test was done.

The exception is if a provider made a billing error. If a location billed you instead of Medicare by mistake, ask them to correct the claim and bill Medicare instead. Most will do this without argument.

At-home tests are useful for your own peace of mind, but Medicare does not cover them. If you want a covered test, go to a provider location and ask them to order it for you.

If you do not have Medicare Part B

COVID-19 test coverage is part of Medicare Part B. If you have Part A only (hospital insurance) and have not signed up for Part B, you are not covered for outpatient tests. Part A covers tests only if you are admitted to the hospital as an inpatient.

If you are past your initial enrollment period and did not sign up for Part B, you may be able to enroll during the General Enrollment Period (January 1 to March 31 each year), though you may face a late enrollment penalty. Contact Social Security or Medicare to discuss your options.

Frequently Asked Questions

Do I need a referral from my primary care doctor to get a COVID-19 test?

No. Any doctor, nurse practitioner, or physician assistant can order a test for you. You do not need a referral from your primary care doctor. You can go directly to an urgent care clinic, a pharmacy, or any other provider location and ask for a test.

Will Medicare cover a COVID-19 test if I do not have symptoms?

Yes. Medicare covers COVID-19 tests whether or not you have symptoms. A provider might order a test if you have been exposed to someone with COVID-19, before surgery, before visiting a family member in a nursing home, or for other reasons. As long as a provider orders it, Medicare will cover it.

What if my pharmacy says they cannot bill Medicare for a COVID-19 test?

Ask to speak with the pharmacy manager and explain that Medicare covers COVID-19 tests. Most pharmacies are set up to bill Medicare and will do so once you clarify. If they still refuse, try a different pharmacy or call your doctor's office to order the test instead.

Can I get a COVID-19 test through telehealth and have Medicare pay for it?

A telehealth visit can result in a provider ordering a test, but the test itself must be done at a physical location that Medicare recognizes — you cannot do a telehealth visit and then use an at-home test kit and expect Medicare to pay. The provider can order the test during the telehealth visit, and then you go to a clinic or pharmacy to have it done.

Do I have to show my Medicare card when I get a COVID-19 test?

Yes. Bring your Medicare card so the provider can verify your coverage and bill Medicare directly. If you do not have your card with you, tell the staff your Medicare number (it is on your Social Security card if you cannot find your Medicare card), and they can look up your information.