Michigan Association of Health Plans

What COVID-19 test is best? Who pays in Michigan? What you need to know.

As athletes return to practice fields, travelers board planes, and employers struggle to keep employees and customers safe, testing for COVID-19 is becoming part of Michigan’s new normal.

But consumers face a dizzying array of information — much of it incomplete. Which test works best? How often should I take one? Will I have to pay for it?

Having so many choices can be confusing. That’s in part because there are many different kinds of tests.

The U.S. Food and Drug Administration suspended its normally rigorous requirements for test development during the pandemic, allowing hospitals and private labs across the country to quickly develop COVID-19 tests with still-unproven levels of reliability and varying promises of speed and ease.

That means the reliability of some tests may be “limited,” because “a low threshold of detection studies are needed to achieve FDA (emergency use authorization) status,” the American Academy for Family Physicians advised its members.

The FDA authorized more than 150 tests from a variety of manufacturers, all approved under its emergency use authorization powers.

Here’s what’s known on some common questions:

Which is the right test for me?

Broadly speaking, there are two types of tests and they offer very different pieces of information.

The first category of tests is a diagnostic, or viral, test. It’s intended to tell you if you are currently infected.

The test checks respiratory system samples from inside your nose or throat or, in some cases, from saliva. There are two types of diagnostic tests.

A molecular test, known as a PCR, is named for the laboratory technique (polymerase chain reaction) that amplifies the virus’ genetic material in order to detect it. It is generally believed to be the most reliable test for COVID-19.

Does it matter if the sample is collected from your nose, throat or saliva? It may.

A recent Yale study indicated the saliva test was more accurate in detecting infection than the nasal test. But regardless of where the sample is collected, a test’s reliability can also be impacted by the person collecting the sample (human error is usually the biggest factor in reliability, rather than the test itself) and the timing of the test (accuracy can drop dramatically five to seven days after the start of the infection).

A second kind of diagnostic test, an antigen test, looks for proteins from the virus. This test is also collected from nasal or throat swabs, but is less reliable than a molecular test, according to the Mayo Clinic. Recognizing this, doctors may order a follow-up molecular test if the result from the antigen test is negative, said Dr. Subhashis Mitra, an infectious disease expert and interim chief of the Infectious Diseases Division at the Michigan State University College of Human Medicine.

The other category of testing is the antibody, or serology, test, and is generally used to determine if you were infected. Put another way, the tests detect whether you’ve had an immune response to the virus rather than the virus itself. It can be performed with a single finger prick.

Here too, timing matters. Antibodies can take a while to build. If the test is conducted too early, there may not be sufficient antibodies to detect. And it’s not clear whether antibodies fade quickly.

The FDA has listed serology test options here, along with varying levels of their reliability.

What do COVID-19 tests cost, and who pays for them?

Generally speaking, consumers shouldn’t have to pay out of pocket for COVID-19 testing. But there are some caveats.

If a test is “medically indicated” — for example, you need it because you are sick or as a precaution before a medical procedure — Michigan insurers will cover the  cost of the test, said Jeff Romback, deputy director of policy and planning at the Michigan Association of Health Plans, which represents most of Michigan’s large insurers.

Most Michigan insurers offered full coverage even before the Families First Coronavirus Response Act (FFCRA) mandated it, he said.

Still, what’s medically appropriate can be open to interpretation, said Samantha Iovan, a senior analyst at the Ann Arbor-based Center for Health & Research Transformation.

Federal guidance dictates insurers must pay “when medically appropriate for the individual, as determined by the individual’s attending health care provider.”

But one doctor might deem a test “medically appropriate” before visiting an elderly relative, while another may not, she said.

And keep in mind that even if your COVID-19 test is covered by insurance, you could be charged for other tests not related to the virus. For example, if you are tested for the flu or other illnesses at the same time, you may be on the hook for those charges.

In addition to individual insurance coverage, COVID tests often are covered through other sources during the pandemic. In some cases, employers who require workers to take diagnostic tests may pick up the costs, but that’s also in flux and may be open to interpretation.

In Michigan, state government foots the bill for diagnostic testing among nursing home staff and residents — testing required under an executive order by Gov. Gretchen Whitmer.

American Red Cross financial donors are covering costs of antibody tests for blood donors, said Kuhlman of the Red Cross.

And this week, Rite Aid announced it was expanding testing throughout the country, including in Michigan. The pharmacy giant now operates 258 test sites throughout the U.S.

These sites do not require insurance; rather, the U.S. Department of Health and Human Services will pick up the cost at least through August, said Chris Altman, manager of clinical programs for the chain.

“There’s an incredibly high demand, so we know that people are looking for this … They just want to know ‘Do I have it? Do I not have it? Am I exposing others? Am I not exposing others? Do I have to quarantine?’” Altman said.

CVS also offers testing at some 1,400 sites nationwide. Insurance will cover the costs. But for the uninsured, federal funding picks up the tab, according to spokesman Joe Goode.

This article was originally featured on Bridge Michigan, read more here.