MVP does not cover COVID-19 tests performed solely to assess health status, even if required by parties such as government/public health agencies, employers, common carriers, schools, or camps, or when ordered upon the request of a member solely to facilitate the member’s desire to self-assess COVID-19 immune status. MVP does not cover occupational testing.
Over-the-Counter Test Coverage
MVP will cover the cost of certain FDA-authorized over-the-counter (OTC) take-home COVID-19 antigen tests for NYS Medicaid, Child Health Plus, and Essential Plan members, New York and Vermont commercial members, and self-funded plan participants.
- Child Health Plus Effective January 21, 2022, Child Health Plus (CHP) members receive two FDA-authorized COVID-19 test kits, per week, with no cost-sharing.
- New York and Vermont commercial members and self-funded plan participants Effective January 15, 2022, New York and Vermont commercial members and self-funded plan participants may be reimbursed for up to eight retail OTC COVID-19 antigen tests, per covered dependent per 30 days.
- Essential Plan Effective January 3, 2022, Essential Plan (EP) members may receive up to two FDA-authorized OTC COVID-19 test kits per week until the end of the Public Health Emergency.
- Medicaid Effective December 13, 2021, NYS Medicaid members may receive two retail OTC COVID-19 antigen tests per week (maximum of eight tests per month) at an in-network pharmacy department with no cost-share by presenting their MVP Member ID card. Coverage is limited to certain FDA-approved tests.
- Vermont commercial members Effective December 1, 2021, through January 14, 2022, Vermont commercial members may be reimbursed for up to eight retail OTC COVID-19 antigen test kits per covered dependent per month (maximum of 16 tests per covered dependent per month).
For a complete list of OTC tests available for coverage for commercial, CHP, and EP members, and self-funded plan participants visit the FDA website.
Medicaid, Child Health Plus (CHP) and Essential Plan (EP) Test Coverage
Medicaid, CHP, and EP members have the following OTC tests covered*. Tests must be purchased at an in-network pharmacy:
- BinaxNOW™ COVID-19 Antigen Rapid Self-Test
- CareStart COVID-19 Antigen Home Test
- FlowFlex™ COVID-19 Antigen Home Test
- iHealth COVID-19 Antigen Home Test
- InteliSwab™ COVID-19 Rapid Test
- QuickVue® At-Home OTC COVID-19 Test
Currently, there is no regulation or requirement for Medicare insurers to cover OTC at-home tests.
*This information is subject to change. Covered tests for Medicaid, CHP, and EP are determined by New York State Department of Health (NYS DOH), and list will be updated as information from NYSDOH becomes available.