Humana Provider COVID-19 testing options FAQs

Note: As the public health crisis continues to evolve, we will continue to evaluate and implement changes to the Humana testing program to ensure the best end-to-end experience for you and your patients.

COVID-19 testing: Humana coverage

1. Will Humana cover COVID-19 testing?

Humana covers a wide range of COVID-19 tests, including at-home, over-the-counter (OTC) tests as well as tests performed in laboratories. Please read the following FAQs closely, as coverage may vary depending on specific plan and type of test.

2. What is Humana doing to comply with the federal at-home, OTC COVID-19 test kit requirements?

Humana is committed to complying with these requirements and covering the cost of at-home, OTC COVID-19 test kits for our members within the limitations outlined below.

Humana Medicare Advantage and Medicaid members:

Beginning April 4, 2022, the Centers for Medicare & Medicaid Services (CMS) announced that Medicare beneficiaries with Part B coverage, including those enrolled in Medicare Advantage, will be eligible for up to 8 OTC COVID-19 tests from participating pharmacies and providers each calendar month until the end of the COVID-19 public health emergency (PHE). Those with Part A-only coverage will not be eligible.

Individuals can get OTC COVID-19 tests at any pharmacy or health care provider who participates in this initiative even if he/she is not a current customer or patient. There may be more than 1 test per box, so 8 tests may come in fewer than 8 boxes. Medicare will not cover costs for OTC COVID-19 tests obtained prior to April 4, 2022.

NOTE: If your patients do not have their Original Medicare card or do not know their 11-digit Medicare Beneficiary Identifier (MBI) number, use the MBI look-up tool in your MAC’s secure portal (PDF), PDF – you must have your patient’s first name, last name, date of birth and Social Security number. Even if your patients are enrolled in Medicare Advantage plans, you can look up their MBIs.

Those with Medicaid coverage should contact their state Medicaid office for information regarding the specifics of coverage for at-home, OTC COVID-19 tests, as coverage rules may vary by state.

Humana commercial group members (those who receive insurance through their employer):

As announced by the U.S. Department of Health and Human Services, as of Jan. 15, 2022, all private insurance members are eligible to receive up to 8 at-home, OTC COVID-19 tests per 30 days (or calendar month) at no out-of-pocket cost. Eligible test kits must meet the following criteria:

  • At-home, OTC, viral test kits for personal use that people can take and read at home without the help of a healthcare provider
  • Viral test kits that test for current infection; antibody/serology tests are not included
  • Only at-home, OTC test kits that are approved by the US Food & Drug Administration (FDA) will be covered. To find out which test kits are included, visit the FDA At-Home OTC COVID-19 Diagnostic Tests list.
  • Test kits purchased for employment screening or public health surveillance purposes are not eligible for coverage.
  • Please be aware that each test is counted separately even if sold in packs that contain multiple tests. For example, if a box that contains 2 tests is purchased, it will count as 2 tests toward the monthly limit of 8.

PLEASE NOTE: Humana does not manufacture or make available these at-home, OTC COVID-19 tests for members. Tests may be found at local pharmacies, local stores or trusted online retailers. The federal government has also set up a website where each family can get 4 free tests: www.covid.gov/.

Commercial group members have three options to get covered at-home, OTC COVID-19 tests for a total of 8 tests per 30 days (or calendar month):

  1. Purchase online at CVS.com using their insurance card for a $0 copay
  2. Purchase in-store at an in-network pharmacy counter for a $0 copay
  3. Pay the full amount for the test up-front at a pharmacy or another trusted retailer in-store or online and file a reimbursement claim and be reimbursed up to $12 per test

3. Is a referral, authorization or prescription required to obtain an at-home, OTC COVID-19 test?

Humana commercial group members:

At-home, OTC COVID-19 tests do not require a referral, authorization or prescription. Humana members are eligible to receive up to 8 at-home, OTC COVID-19 tests per 30 days (or calendar month) at no out-of-pocket cost.

Humana Medicare Advantage and Medicaid members:

At-home, OTC COVID-19 tests do not require a referral, authorization or prescription. Humana Medicare Advantage members are eligible to receive up to 8 at-home, OTC COVID-19 tests per 30 days (or calendar month) at no out-of-pocket cost. Those with Medicaid coverage should contact their state Medicaid office for information regarding the specifics of coverage for at-home, OTC COVID-19 tests, as coverage rules may vary by state.

4. Does Humana still cover the cost of tests ordered by a physician or other licensed healthcare professional?

Humana commercial group members:

Humana commercial group members will continue to be eligible for COVID-19 testing with no out-of-pocket costs when a US Food & Drug Administration (FDA) or emergency use authorized COVID-19 test (including at-home tests) has been ordered by a physician or other licensed healthcare professional because the member:

  • Has COVID-19 symptoms,
  • Has been exposed to someone with suspected or confirmed COVID-19, or
  • Requires pre-admission or pre-procedural testing in an asymptomatic individual.

Humana commercial group members may NOT be eligible for coverage of COVID-19 testing for any indications other than those listed above including, but not limited, to:

  • Employment (e.g., pre-employment, return to work) or school purposes (e.g., return to school);
  • Entertainment purposes (e.g., prior to a concert or sporting event);
  • General population or public health screening;
  • Physicals (executive or routine);
  • Screening in a congregate setting;
  • Sports participation; or
  • Travel purposes.

Humana commercial group members are encouraged to check their plan documents for more details about their 2022 coverage.

Humana Medicare Advantage and Medicaid members:

During the public health emergency, there will be no out-of-pocket costs for Humana Medicare Advantage and Medicaid members who receive a US Food & Drug Administration (FDA) or emergency use authorized COVID-19 test that is performed by a laboratory, when the test is ordered by a physician or other licensed health care professional. Medicare will cover one lab-performed test per member per year without an order. Testing locations may require an order or prescription. It is recommended that members contact the testing location for details.

Ordering COVID-19 testing

5. What are the COVID-19 patient testing options for providers?

  1. Walmart and Quest Diagnostics have collaborated to offer testing at more than 500 Walmart Neighborhood Market drive-thru pharmacy locations across the country. Providers have the ability to electronically order the Walmart drive-thru testing through the Quest Quanum portal or interfaced EHR for their patients. Instructions on how to place a COVID-19 lab order in Quest can be found here, PDF.
  2. Providers have the ability to order an at-home test kit electronically through any standard LabCorp account using an interfaced EHR system or LabCorp Link™. To set up LabCorp at-home ordering for your LabCorp account, contact your local LabCorp account representative. Providers will be prompted to enter the patient’s home address and contact information. A test kit is sent overnight to the patient’s home for self-collection. The patient performs a simple nasal wipe using a foam swab and places the kit in a prepaid FedEx envelope for routing to LabCorp. Results are delivered directly to the provider’s EHR.
  3. Providers can order Laboratory Supplies through their existing lab partner to perform a COVID-19 PCR collection themselves. Providers should contact their existing lab partner to learn how to place a supply order. If the provider runs into any difficulty ordering supplies, contact your Humana representative for assistance.

These three options are not the only testing options available for Humana members. Providers can refer their patients to other testing sites across the country. Members can call Humana at the number on the back of their Humana ID card and we’ll help identify a nearby testing site.

6. If a provider does not have Quest Quanum, do they have access to a free version for ordering COVID-19 testing?

Yes. Providers can follow the steps below.

  1. Visit QuestDiagnostics.com/QuanumHCP
  2. If you have a Quanum eLabs account (formerly Care360®) use your existing credentials; this is all you need to log in
  3. If you were set up with a Care360 account that has expired, you can update your account by resetting your password on the main login page
  4. If you don’t have an account, create one by clicking on “Get Access Now”

7. When ordering the drive-thru test in Quest Quanum, how do providers know which Walmart location to send the patient? Is there a testing locator tool within Quest Quanum?

Once an Order-on-Hold is placed by the ordering provider, it becomes accessible at all available Walmart drive-thru locations. The collection site locator tool is within www.MyQuestCOVIDTest.com or the Quest Diagnostics Patient Scheduling. Providers can also contact their Quest Representative to understand the Walmart options that are in proximity to their practice.

8. How long will it take for the patient to receive his/her drive-thru test results?

Results for tests ordered through Quest should be available through the MyQuest portal within 2-4 days.

9. What is the process for administering the drive-thru test?

Patients will receive a testing kit from through the drive-thru window tray, self-administer the nasal swab, place the swab in a container and seal the plastic bag. This process will be observed by a pharmacist behind the drive-thru window. Patients will then drop the specimen in a collection bin before they drive away. Quest will pick up the samples for testing. No testing samples will enter the pharmacy.

10. How can a provider order an at-home test for their patient using LabCorp?

Providers have the ability to order an at-home test kit electronically through any standard LabCorp account using an interfaced EHR system or LabCorp Link™. To set up LabCorp at-home ordering for your LabCorp account, contact your local LabCorp account representative. Providers will be prompted to enter the patient’s home address and contact information. A test kit is sent overnight to the patient’s home for self-collection. The patient performs a simple nasal wipe using a foam swab and places the kit in a prepaid FedEx envelope for routing to LabCorp. Results are delivered directly to the provider’s EHR.

11. How long after a provider orders an at-home test for his/her patient should it be expected to arrive?

The test is overnighted to the member as soon as the order is received—1–2 days, depending on when the order is placed.

12. How long will it take for the provider to receive the patient’s at-home test results?

The average time for this process is 24-48 hours after the specimen is received by the lab with the results being delivered directly to the provider’s EHR.

13. What is the process for self-administering the at-home test?

The test kit includes comprehensive, step-by-step instructions for collecting the sample. The member will open the kit and remove a nasal swab from the kit. They insert the swab into each nostril, place the swab in the test tube container and seal in a plastic bag before mailing. The member should follow the provided step-by-step instructions carefully to ensure proper collection and mailing occurs.

Unlike some COVID-19 diagnostic tests, the LabCorp home test does not require someone to insert the swab deep into the nasal passage. Should members have questions, they may call a toll-free hotline for assistance.