Over-the-Counter COVID-19 Rapid Tests for L.A. Care Covered and PASC-SEIU Homecare Workers Health Care Plan Members

Starting January 15, 2022, L.A. Care members in our commercial L.A. Care Covered ™, L.A. Care Covered Direct™, and PASC-SEIU Homecare Workers health plans may obtain up to eight (8) FDA approved, over-the-counter COVID-19 rapid antigen tests per month per enrollee at no cost through a network pharmacy. Please view our Frequently Asked Questions below for details.

 
What is the "rapid, over-the-counter COVID-19 test" benefit?

Starting January 15, 2022, L.A. Care members in our commercial L.A. Care Covered , L.A. Care Covered Direct, and PASC-SEIU Homecare Workers plans may obtain up to eight (8) FDA approved,  over-the-counter COVID-19 rapid antigen tests per month per enrollee at no cost through an L.A. Care network pharmacy. Online shipping options available through CVS Pharmacy (reimbursement up to $12).

If these members choose to purchase an eligible test at any other retail store, they will be reimbursed up to $12 per test, per federal guidelines. Proof of purchase will be required.

 
Who is eligible for this benefit?

L.A. Care Covered, L.A. Care Covered Direct, and PASC-SEIU Plan members. You must show your L.A. Care member ID card to verify eligibility.

What COVID-19 tests are covered?

FDA approved, over-the-counter COVID-19 rapid antigen tests. Please consult with your pharmacist to confirm FDA approval.

Where can commercial members purchase an over-the-counter COVID-19 test?
Can I just grab the test off the shelf and go to the cashier?

At retail locations such as CVS, to obtain the test at no cost, you must pick up the test through the pharmacy. You must show your L.A. Care member ID card to verify eligibility.

You may purchase the test at the cashier, but will need to submit supporting documentation for reimbursement (up to $12).

How can I find one of L.A. Care's network pharmacies?

Pharmacies may be found in the online provider network directory

What are the benefit limits for over-the-counter COVID-19 tests?

Up to eight (8) FDA approved, over-the-counter COVID-19 tests per eligible member per calendar month.

Will I have to pay for my over-the-counter COVID-19 rapid antigen tests up front?
  • At L.A. Care Network Pharmacies: No, if you obtain a test at a network pharmacy, you should not be charged. Please note that at locations such as CVS, you should request the tests from the pharmacy department. 
     
  • At Out-of-Network Locations: If you purchase an FDA-approved over-the-counter COVID-19 rapid antigen test, you will be reimbursed by L.A. Care for up to $12 per test, per federal guidelines.
Are multiple pack tests considered one test?

No. Multiple pack tests are counted by the number of tests included in the packet. For example, if a test packet includes two tests per packet, this counts as two tests. 

What brands are covered?

Only tests approved by the FDA are covered. Inquire with your pharmacy about which tests are FDA approved.

Do I have to purchase the tests at the same time?

No. The tests can be purchased at any time during a calendar month for the duration of the public health emergency.

How long will this program run?

This benefit will be available to eligible commercial members until the federal government ends the public health emergency, or until otherwise advised by the Centers for Medicare and Medicaid Services (CMS).

If I do not purchase tests one month, can I purchase more later (e.g. 16 in one month)?

No. The number of tests eligible for reimbursement are on a per month basis and are not cumulative.

Can I use these tests for my employer mandated testing?

No. This benefit does not cover tests, including over-the-counter COVID-19 tests, that are for employment purposes.  Please contact your employer for its COVID-19 testing guidelines.

What if I cannot find an over-the-counter COVID-19 test, and I need to be tested?
There is currently a nationwide shortage of over-the-counter COVID-19 tests. You can call local network pharmacies in your area to find out if the tests are in stock.
 
  • You may also schedule a test (e.g. Antigen or PCR) at a testing site near your home. Please visit the County's Testing website to find a testing site near you. 
     
  • Starting on January 19, you will be able to order an over-the-counter COVID-19 rapid antigen test at COVIDtests.gov, at no cost. 
How can I be reimbursed for tests I have purchased?

*Eligible purchases may be submitted for reimbursement by contacting our Member Services 1-855-270-2327 (TTY 711). Please have the following documentation available:

  • Copy of purchase receipt with the following printed on the receipt:
  • Member/Subscriber Name
  • Facility Name
  • Date of Service
  • Amount requesting reimbursement

*Eligible purchases are those described in the benefit: Starting January 15, 2022, L.A. Care members in our commercial L.A. Care Covered , L.A. Care Covered Direct, and PASC-SEIU Homecare Workers plans may obtain up to eight (8) FDA approved, over-the-counter COVID-19 rapid antigen tests per month per enrollee at no cost through an L.A. Care network pharmacy. Online shipping options are available through CVS Pharmacy (reimbursement up to $12).

If these members choose to purchase an eligible test at any other retail store, they will be reimbursed up to $12 per test, per federal guidelines. Proof of purchase will be required.