The cost of COVID-19 testing is highly unpredictable, especially for those without health insurance. The final amount a patient pays is influenced by the type of test, where it is administered, and their insurance status, and is rarely the same as the provider’s initial list price. The end of the federal Public Health Emergency (PHE) on May 11, 2023, transitioned many previously free services to commercial pricing models and introduced cost-sharing. Understanding the various pricing tiers and coverage rules is the first step toward finding an affordable testing option today.
Understanding the Base Retail Price
When an individual lacks insurance coverage, they face the full retail cost, often called the “cash price” or “self-pay” rate. For at-home, over-the-counter (OTC) rapid antigen tests, the price is generally transparent, ranging from $10 to $25 for a two-test kit at major retailers. These tests are the least expensive option and provide results within minutes, but their accuracy is lower than laboratory-processed tests, particularly early in the infection.
Clinical tests performed in a medical setting, such as an urgent care clinic or hospital, have a significantly higher price tag that varies by test type. A clinical antigen test for an uninsured person has a median self-pay rate of approximately $51, while the more accurate PCR test averages around $91. The institutional “billed charge” or list price is often much higher, sometimes ranging from $80 to over $250, depending on the provider and state. The “cash price” is a negotiated, lower rate offered to self-pay patients, distinct from the inflated list price billed to insurance companies.
Coverage Through Private Health Insurance
The termination of the federal Public Health Emergency in May 2023 fundamentally changed mandatory zero-cost coverage for private insurance holders. Federal law previously required most private plans to cover both over-the-counter and clinical COVID-19 tests without cost-sharing, such as copays or deductibles. Since that federal mandate no longer exists, private plans are now permitted to impose cost-sharing on medically necessary laboratory tests.
This shift means a patient with private insurance may now be responsible for a copayment, coinsurance, or the full cost until their annual deductible is met. The federal requirement for insurers to reimburse for up to eight at-home tests per month also ended with the PHE. While some insurers may voluntarily continue coverage, most private plans now subject COVID-19 tests to the standard rules of the policy. Out-of-pocket costs are now a possibility, depending entirely on the individual plan’s design and network status.
Federally Funded and Low-Cost Options
Several government-supported avenues still exist for obtaining low-cost or free testing. Medicare Part B continues to cover laboratory-based COVID-19 PCR and antigen tests with no out-of-pocket cost, provided the test is ordered by a healthcare provider. Medicare generally does not cover over-the-counter at-home test kits following the end of the PHE, unless a specific Medicare Advantage plan includes it as an added benefit.
For Medicaid and the Children’s Health Insurance Program (CHIP) enrollees, federal law mandated continued coverage for all COVID-19 laboratory and at-home tests without cost-sharing through September 30, 2024. After that date, coverage policies may vary state by state. Although the federal program that previously shipped free at-home tests to U.S. households has concluded, free testing is often accessible through local community health centers and state or local health departments. These centers utilize federal funding to offer services on a sliding-scale or no-cost basis, regardless of insurance or immigration status.
How Test Type and Location Impact Cost
The final price of a COVID-19 test is significantly driven by the testing methodology and the setting in which it is administered. Molecular tests, specifically the Polymerase Chain Reaction (PCR) test, are the most accurate for detecting the virus’s genetic material and require laboratory processing. PCR tests are the most expensive type of test due to the specialized equipment and trained personnel required for the amplification process.
In contrast, rapid antigen tests detect specific viral proteins and are faster and less expensive. The location of the test introduces a major cost variable, as testing in a high-acuity setting such as an Emergency Room (ER) can lead to substantial facility fees and higher charges. Receiving a test in a primary care office or a retail pharmacy clinic is often a more affordable route, as these settings do not carry the same high overhead costs as an ER. The associated visit fee for the provider to order the test can add a separate charge, sometimes averaging around $90 for an outpatient visit.