Get $0 OTC COVID-19 test kits at your local pharmacy

You may obtain $0 over the counter (OTC) COVID-19 test kits if you purchase them from the counter of an in-network pharmacy and show your Priority Health member ID card at the point of purchase.* See details and exclusions below.

*Exception: Members whose pharmacy benefits are not administered through Priority Health.

How to get free rapid tests from the federal government

As of Jan. 19, 2022, all members can order free rapid tests shipped to your home at covidtests.gov.

I have an employer-sponsored or MyPriority plan. How can I get $0 OTC COVID-19 test kits at my pharmacy?

You may obtain $0 over the counter (OTC) COVID-19 test kits if you purchase them from the counter of an in-network pharmacy and show your Priority Health member ID card at the point of purchase.*

This is subject to test kit availability at the pharmacy. Note: Members may purchase up to eight (8) individual (or four (4) 2-pack) kits over the counter (OTC) per covered individual within a 30-day period without a prescription from a health care professional.

You can use the Find a Doctor tool to find an in-network pharmacy for your plan.

*Exception: Members whose pharmacy benefits are not administered through Priority Health.

I have an employer-sponsored or MyPriority plan. Can I get reimbursed if I purchase OTC COVID-19 test kits?

If you have a MyPriority or employer-sponsored plan with pharmacy benefits through Priority Health and you purchase an over the counter (OTC) COVID-19 test from an authorized retailer, you will be eligible for reimbursement if:*

  • The at-home test you received is approved by the Food and Drug Administration.
  • You fill out and submit the reimbursement form, with the UPCs (barcode on the test kit packaging) and original receipts from the authorized pharmacies or retailers as proof of purchase.
  • Lastly, there is a limit of 8 tests or 4 kits per member per month.

Note: We are unable to reimburse for purchases from non-authorized sources including neighbors, Facebook Marketplace, etc.

  • Reimbursement from ESI may take up to 6-8 weeks.
  • Reimbursement will be in the form of a check mailed to the health plan subscriber even if the kits were purchased for covered members on the plan.

We acknowledge the limited availability of tests in some areas based on high consumer demand and nationwide supply shortages. Some pharmacies may have a limited supply or may place restrictions on how many test kits you may purchase at one time.

  • Members may purchase up to eight (8) individual (or four (4) 2-pack) kits over the counter (OTC) per covered individual within a 30-day period without a prescription from a health care professional.
    • Note: COVID testing ordered by a health care professional when the test is medically necessary to diagnose and treat a patient’s symptoms continues to be covered 100%, with no member cost sharing applied and no limit to the number of tests.
  • Workplace mandated testing is not covered.

*Exception: Members whose pharmacy benefits are not administered through Priority Health.

I have a Medicare plan. Can I get reimbursed if I purchase OTC COVID-19 test kits?

At this time, legislation from the Biden-Harris Administration applies to individuals with private health insurance coverage or those covered by a group health plan only.

If you’re experiencing symptoms, we recommend that you first speak to your health care provider to help you understand if you need a PCR test. Your provider will be able to assist with the scheduling process.

  • Currently, COVID-19 test coverage for Medicare members requires a lab.
    • Medicare pays for COVID-19 diagnostic tests performed by a laboratory, such as PCR and antigen tests, with no beneficiary cost sharing when the test is ordered by a physician, non-physician practitioner, pharmacist, or other authorized health care professional.
    • Medicare members can access one lab performed test without cost sharing per patient per year without an order.

I have a Medicaid, Children’s Special Health Care Services (CSHCS), or Healthy Michigan plan. Can I get free at-home COVID-19 test kits?

At-home COVID-19 tests for Medicaid, Children’s Special Health Care Services (CSHCS), or Healthy Michigan plan members are covered. Members may obtain free at-home tests two ways:

  • Option one: From a pharmacy according to Medicaid Policy
    • A pharmacy dispenses the COVID-19 test as a prescription.
    • The at-home COVID-19 tests you receive is Medicaid covered and approved by the Food and Drug Administration (FDA).*
    • The at-home test dispensed as a prescription is used in accordance with CDC definitions and recommendations.
    • The quantity of at-home tests dispensed as a prescription does not exceed 1 test per member per day.
    • The prescriber and dispensing pharmacy are Medicaid-enrolled.

  • Option two: If you purchase an over the counter (OTC) COVID-19 test from an authorized retailer**, you will be eligible for reimbursement if:
    • The purchase was made April 1, 2022 to present.
    • The at-home COVID-19 test purchased is Medicaid covered and approved by the Food and Drug Administration (FDA).*
    • Members may be reimbursed for up to eight (8) over the counter (OTC) tests per calendar month without a prescription from a health care professional.
    • Reimbursement will be equal to the total expense paid, up to $12.00 per test.
    • Members should fill out and submit the reimbursement form, with the UPCs (barcode on the test kit packaging) and original receipts from the authorized pharmacies or retailers as proof of purchase.
 

*Determined by MDHHS. Subject to change, a list of Medicaid-covered National Drug Codes (NDCs) applicable to the above tests is available at michigan.magellanrx.com.

**At-home COVID-19 tests are not eligible for reimbursement when purchased from a private individual via an in-person or online person-to-person sale or from a seller that uses an online auction or resale marketplace are not eligible for member reimbursement. Additionally, over-the-counter COVID-19 home tests reimbursed by another source, supplied for free to the member, or covered through the member’s pharmacy benefit plan are not eligible for DMR reimbursement by the health plan. 

At-home tests are not covered for Medicaid beneficiaries who are Medicaid-Medicare Dual Eligible (Priority Health group 10004). Dual Eligible Medicaid beneficiaries should refer to their Medicare plan for coverage.

What is the difference between a booster and an extra or additional dose?

Many terms are being used in the news these days. Experts at Johns Hopkins Medicine make the following distinction when talking about vaccines:

Booster: A COVID booster shot is an additional dose of a vaccine given after the protection provided by the original shot(s) has begun to decrease over time. Typically, you would get a booster after the immunity from the initial dose(s) naturally starts to wane. The booster is designed to help people maintain their level of immunity for longer.

Additional dose: An additional dose, originally called a third dose, is given to people with moderately or severely compromised immune systems to improve their response to the initial vaccine series. (The term “third dose” was used to refer to additional doses for the two mRNA vaccines, but now the term is “additional dose” because those who received a J&J “one dose” may also be eligible for a dose based on their immune systems.)

Extra dose: another way to phrase “additional dose”

(Johns Hopkins Medicine)

Are the COVID-19 booster shots and additional doses covered?

Yes. All COVID-19 vaccine doses will be available at no cost to all Priority Health members.*

*Exception: Members enrolled in grandfathered and retiree commercial plans should check their plan documents to determine vaccine coverage.

Will there be any costs associated with the COVID-19 booster shots or additional doses?

No. Priority Health will be covering any costs associated with the COVID-19 vaccine third dose. You should not receive any type of bill for the COVID-19 vaccines.

*Exception: Members enrolled in grandfathered and retiree commercial plans should check their plan documents to determine vaccine coverage.

How long will you be offering the booster shots and additional doses for $0?

As long as the booster shots and additional doses are recommended by the CDC, Priority Health will cover them at $0 as part of our preventive care services offered under most Priority Health plans.

*Exception: Members enrolled in grandfathered and retiree commercial plans should check their plan documents to determine vaccine coverage.

When and where can I get my booster shot or additional dose?

Check with your primary care provider to determine whether you or a family member needs a booster shot or additional dose. Pharmacies, mobile vaccination clinics, and local vaccination sites offer appointments for all COVID-19 vaccine doses.

Are you still covering the initial COVID-19 doses?

Yes. The COVID-19 initial doses are still available at no cost to Priority Health members. See next section.

Is the COVID-19 vaccine covered?

The COVID-19 vaccine is available at no cost to all Priority Health members.

Note: You may receive a bill for administration of the vaccine if you use an out-of-network provider. See "Will I get a bill for the vaccine?" below for more information. 

Will I get a bill for the vaccine?

In-network

No. If you see an in-network provider you shouldn’t receive any type of bill for your vaccine.

Out-of-network

If you receive your vaccine from an out-of-network provider, we can't guarantee that a provider will not bill for any balance amounts for the administration of the vaccine. Note that the government pays for the vaccine itself.

Out of network providers don't have negotiated contract rates with Priority Health. Therefore, as is the standard practice of other health plans, we will use usual, customary and reasonable rates (UCR) to determine how much to pay an out-of-network provider.

What are usual, reasonable and customary rates (UCR)?

UCR is the amount that is paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service. The UCR amount sometimes is used to determine the allowed amount.

Learn more about UCR.

How do I know when I am eligible for a vaccine?

The vaccines and boosters are rolled out in phases, determined by the federal and state government based on recommendations by the Centers for Disease Control and Prevention.

Michigan residents 5 and older can get a COVID-19 vaccine.

How do I get a vaccine?

The Michigan Department of Health and Human Services has advised that eligible individuals can receive a vaccination by appointment through local health departments.

Additionally, other providers like retail pharmacies and hospitals have created their own registration and scheduling as they receive vaccine supplies. We recommend making appointments at your most convenient locations as they become available.

How do I know where vaccines are available?

MDHHS has provided the following direction:

If you are 5 and older visit michigan.gov/COVIDvaccine and select vaccine location to make an appointment.

Medicare members: Remember to bring your red, white and blue Medicare card to your appointment.

If you are an essential frontline worker, you may be notified about how and where to get a vaccine by your employer. You may also visit michigan.gov/COVIDvaccine for the most up-to-date information.

Members age 5 and older are now eligible to receive a COVID-19 vaccine.**

**The Pfizer COVID-19 vaccine is now authorized and recommended by the FDA and CDC for children ages 5-11.

You can learn more about COVID-19 vaccines for children and teens at CDC.gov.

Find where to schedule your vaccine

Need more information about the COVID-19 vaccine?

The MDHHS website provides in-depth information on the statewide vaccine rollout, locations and information on the safety and testing of the vaccine. Visit michigan.gov/COVIDvaccine for the latest information.

Helpful COVID Vaccine FAQs from the experts:

  • MDHHS (Michigan Department of Health and Human Services)
  • CDC (Center for Disease Control and Prevention)
Go to MI.gov
Syringe and injection bottles

Be aware of scams

Here are things you should know in case scammers try contacting you for personal information or money to get the vaccine. Remember: Vaccines are covered at no cost to you.

  • You can’t pay to put your name on a list to get the vaccine.
  • You can’t pay to get early access to a vaccine.
  • Don’t share your personal or financial information if someone calls, texts, or emails you promising access to the vaccine for a fee.