COVID Antigen Test Enrollment Form

Protect yourself and your family from COVID-19 with free, easy to use, self-administered test kits delivered right to your door. Starting April 4, 2022, and through the end of the COVID-19 Public Health Emergency, Medicare is paying for 8 over the counter tests per month at no cost to you if you are a Medicare Part B or Medicare Advantage member. These tests are being provided free of charge by your healthcare provider and will be delivered directly to your house. Please complete the following information to receive your tests. Should you have questions, please contact your healthcare provider to verify your eligibility or call us at (210) 352-5175 (Press option 2 for client services).

First Name*

Last Name*

Address*

City*

State/Region*

ZIP Code*

Date of Birth*

Gender*

Phone number*

Email*

Insurance Company*

Medicare Beneficiary Identifier (MBI) -- OR -- Insurance Policy #*

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FAQ's

What is this program?

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As of April 4, 2022, Medicare covers the cost of up to eight (8) at- home COVID-19 tests each calendar month, at no cost to you. Each person with Medicare Part B can get up to 8 free at home tests for the month and can then get another set of 8 free at-home tests for each calendar month that follows until the program ends.

What is included?

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You’ll receive eight at-home COVID-19 tests which ship for free to your home. These may be packaged individually or packaged in boxes of two kits per box. Your eight (8) at-home texts will come with everything you need, including instructions.

How do I order my free test kits?

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To request your free at-home COVID-19 test kits, just complete the form. Be sure to have your Medicare card ready, as the information you provide will need to match your Medicare card. If you would prefer, you can order by calling us at (210) 352-5175 (Press option 2 for client services).

Does Medicare Part B cover these tests?

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Yes, Medicare Part B (Medical Insurance) will cover the tests.

Does Medicare Part A (Hospital Insurance) cover these tests?

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Medicare Part A won’t cover COVID-19 home tests if you only have Medicare Part A (Hospital Insurance), but you may be able to get free tests through other programs that you have.

Does the Medicare Advantage Plan cover these tests?

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If you are on a Medicare Advantage Plan, you can receive your free tests through Medicare, but not through your Advantage Plan. You might need to show your red, white and blue Medicare card to get your free COVID-19 tests, even if you have another card for Medicare Advantage Plan or Medicare D Plan.

How many home tests can I get at no cost?

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Each person with Medicare Part B can get up to 8 COVID-19 at- home tests at NO COST, every calendar month.

Do I have to pay for the tests?

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Each person with Medicare Part B can get up to 8 COVID-19 home tests at NO COST, every calendar month. If you get more than eight tests in any calendar month, you will be responsible for the costs of the additional tests for that calendar month.

Can I choose what type or brand of test I get?

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All tests distributed as part of this program are FDA-authorized at-home rapid antigen tests. You will not be able to choose the brand you order as part of this program.

Will I be able to track my order status?

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Yes, there is an option for you to provide an email address to receive email notifications with shipping updates. Once your order has shipped you will receive an email with an estimated delivery date and a tracking number. You can track the status of your delivery on USPS.com.

Can I pick up my tests or have them held at my local Post Office instead of having them shipped?

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No, this program is designed to send free tests to your home through the mail.

When should I use my tests?

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The Centers for Disease Control and Prevention (CDC) recommends that you take an at-home test:

If you begin having COVID-19 symptoms such as fever, sore throat, runny nose, or loss of taste or smell, or
At least five days after you come into close contact with someone with COVID-19, or
When you’re going to gather with a group of people, especially those who are at risk of severe disease or may not be up to date on their COVID-19 vaccines.