Health Insurance
COVID-19 Testing Survey: Americans Talk Out-of-Pocket Charges, Bill Negotiations, Barriers
COVID-19 Testing Survey: Americans Talk Out-of-Pocket Charges, Bill Negotiations, Barriers
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Frequent COVID-19 testing is just another in a long line of adjustments many Americans have made since the onset of the coronavirus pandemic. Whether that’s because a job requires routine testing, someone in the house has a preexisting health condition or frequent exposure necessitates it, testing isn’t an unusual activity anymore. But what does that mean for people’s wallets?
To find out, the latest ValuePenguin survey asked more than 2,000 Americans about their experiences with testing, including out-of-pocket charges, bill negotiations and barriers. With that in mind, here’s what researchers found.
- Key findings
- Nearly a quarter of COVID-19 test-takers have had related out-of-pocket expenses
- Are people having success negotiating COVID-19 testing bills?
- 1 in 5 uninsured Americans have skipped COVID-19 testing due to affordability concerns
- Trouble finding at-home test is top barrier for Americans
- Methodology
Key findings
- Nearly a quarter (23%) of COVID-19 test-takers have had out-of-pocket expenses related to the test. On average, those with out-of-pocket costs have spent $120 on tests.
- About half of those who negotiated COVID-19 testing charges were able to get them removed, but only 30% of those charged tried to negotiate. Men were more likely to negotiate than women (35% versus 22%).
- 20% of Americans without health insurance have chosen not to get tested for COVID-19 due to affordability concerns. Overall, uninsured consumers were less likely to have been tested (52%) than those who are insured (65%).
- 87% of Americans think COVID-19 tests should be free for everyone regardless of health insurance. That percentage drops to 83% when asked whether the tests should be free for unvaccinated people.
- 40% of Americans have faced barriers to getting tested, especially at-home test shortages (18%), long lines at testing centers (16%) and difficulty getting an appointment (16%).
Nearly a quarter of COVID-19 test-takers have had related out-of-pocket expenses
Among respondents who said they'd been tested for COVID-19, 23% said they’d been charged out-of-pocket expenses.
To be clear, low- and no-cost COVID-19 tests are available at health centers and certain pharmacies throughout the U.S. — even for those who don’t have health insurance.
Early in the pandemic, insurance companies were required to cover the cost of COVID-19 testing as long as an attending provider deemed it medically appropriate — leaving many decisions open to interpretation. But the Biden administration in February 2021 strengthened requirements to limit costs for consumers.
The administration went even further in January 2022, allowing every U.S. household to order four free at-home tests online via the U.S. Postal Service to be shipped to their homes. In conjunction, people with health insurance can get at-home COVID-19 tests covered or be reimbursed.
Still, there are circumstances where folks may find themselves shelling out cash for COVID-19 tests. Possible examples could include:
- If you need a negative test to travel
- If you need a negative test to return to work
- If you get tested through a private lab
Millennials ages 26 to 41 (30%) were most likely to be charged out-of-pocket costs, as were those earning $75,000 or more (32%).
It may be a matter of frequency, however, since those in the highest income bracket (earning $100,000 or more) were more likely to have been tested than those in the lowest bracket (those who earn less than $35,000 a year) — 70% versus 60%.
And among those who paid out of pocket, the average amount spent on tests was $120. There wasn’t a significant difference in spending between insured ($120) and uninsured ($111) folks.
From a generational standpoint, though, millennials spent the most on COVID-19 tests ($142), compared with:
- Gen Zers (ages 18 to 25): $125
- Gen Xers (ages 42 to 56): $101
- Baby boomers (ages 57 to 76): $59
And men ($139) tended to pay more than women ($96).
What types of tests are Americans taking?
Nearly two-thirds of Americans (64%) have taken a COVID-19 test. By generation, Gen Zers are the most likely to get tested (76%).
Among those who’d been tested, PCR tests administered by a health care professional (62%) were the most common type. These tests can take a few days to get results back. Rapid tests performed by a health care professional (47%) were the second-most-common option cited. These tests give results in 15 to 30 minutes and tend to have low price points, but they can be less reliable for people without symptoms. Rapid tests may require a follow-up test, too.
Both PCRs and rapid tests look for active infections. But there are key differences:
- PCRs work by amplifying a segment of the virus’s genetic material so it can more easily be detected
- Rapid tests look for the protein associated with COVID-19
At-home tests were significantly less common among testers. But for those who did go that route, rapid tests (16%) edged out PCRs (11%). That could indicate a preference for speed over accuracy.
The most common reasons people sought testing were feeling sick (42%) or being exposed to someone who tested positive (41%). Travel ranked third, and people who earned $100,000 or more (24%) and West Coast residents (19%) were the most likely groups to say they got tested to be able to take a trip.
Are people having success negotiating COVID-19 testing bills?
Among those tested and charged, 29% tried to negotiate the bill. And only 16% of Americans were able to negotiate to get the charges removed. Meanwhile, 71% said they didn’t try to negotiate at all, even if they thought they shouldn’t have been charged.
There were a few notable trends as well. Gen Zers, for example, were most likely to negotiate successfully (20%). And a quarter of Americans in the West also found success in negotiating to get testing charges removed. Here’s how it broke down by gender:
"More people should work with health care providers to negotiate COVID testing fees," says Robin Townsend, a ValuePenguin technical writer whose focus is health and life insurance. "It’s always good to save on health care costs where you can, including with COVID tests. There are no downsides to negotiating COVID test charges. Your health care provider won’t know you need help unless you ask, and you should never be penalized for asking."
Negotiating can happen before or after a coronavirus test. And for those worried about potential testing bills, it’s possible to shop around for quotes. That may be useful for those who aren’t sure if they’d qualify for a free test.
1 in 5 uninsured Americans have skipped COVID-19 testing due to affordability concerns
Some folks will probably opt to skip testing whenever cost is a concern. And for some uninsured Americans (20%), there has been at least one time when worries about cost meant skipping a COVID-19 test. That’s almost double the rate of those who have insurance.
Uninsured folks can get free COVID-19 testing through in-person visits. For instance, health care providers that participate in the U.S. Health Resources and Services Administration’s COVID-19 Uninsured Program are required not to bill those without insurance coverage. That includes undocumented immigrants. So, they’re in a similar situation as insured folks who may be charged if they get a test done through an uncovered option, like a private lab.
However, there’s a key difference: Insured Americans have the benefit of cost sharing, while those without insurance don’t. So an uninsured person may have to pay more for a test than an insured person would.
Among all Americans, 13% have opted to go without testing due to cost. And those without insurance (9%) were more likely to have skipped multiple tests, though folks with insurance through the federal marketplace (7%) weren’t far behind.
Should COVID-19 testing be free for uninsured or unvaccinated Americans?
The overwhelming majority of those surveyed (87%) said coronavirus testing should be free, regardless of whether you have health insurance. And 7% said it should be free just to those without insurance.
Another aspect researchers looked at was whether people thought vaccination status should impact who pays for testing. Most people (83%) think it shouldn’t be a factor.
So, overall, Americans seem to be relatively in line with the federal policies surrounding COVID-19 testing costs, which have free options for people regardless of vaccination or insurance status. And the consensus seems to be in favor of expanding those policies to cover more people.
Trouble finding at-home test is top barrier for Americans
Nearly 1 in 5 Americans — whether they were ultimately tested or not — said they had trouble finding at-home tests. Another 16% cited long lines at testing centers, while the same percentage said they had difficulty getting a test appointment.
Across political affiliations, Democrats were most likely to report trouble finding at-home tests (21%). And 29% of those earning $100,000 or more said the same. Finding at-home tests was also the most commonly cited issue among those living in the Northeast (24%), impacting a higher proportion of respondents than any other region.
However, there are new policies aimed at fixing these issues.
New testing option for all Americans
As noted earlier, Americans are now guaranteed up to four free at-home tests per household, regardless of insurance status. Payment details aren’t required to access these tests, either. All you need is your name and shipping address.
The system and requirements for this program aren’t ideal. It limits at-home tests to four per residential address — regardless of the number of residents. It’s also a one-time deal. So for multigenerational households, this option — while helpful — isn’t a long-term solution to the issue of testing access. That’s especially true for those who get sick or are exposed to someone who tests positive.
The tests included in this program are rapid antigen tests, so they won’t be as reliable as PCRs. But they can be especially useful for those who’ve previously skipped testing because of cost concerns.
New testing policy for insured Americans
Another initiative provides up to eight at-home tests per person a month — but that’s limited to insured folks. It also works as a reimbursement for tests purchased at a pharmacy, store or online, rather than getting those tests for free up front. That means people will have to submit a claim to their insurer, including the test receipt, to get that money back.
This policy could be a negative in the minds of Americans who are worried about these costs in the first place.
Still, it does ultimately provide an option for insured folks looking to purchase at-home, over-the-counter COVID-19 tests for free.
Methodology
ValuePenguin commissioned Qualtrics to conduct an online survey of 2,100 consumers from Jan. 19-21, 2022. The survey was administered using a nonprobability-based sample, and quotas were used to ensure the sample base represented the overall population. All responses were reviewed by researchers for quality control.
We defined generations as the following ages in 2022:
- Generation Z: 18 to 25
- Millennial: 26 to 41
- Generation X: 42 to 56
- Baby boomer: 57 to 76
While the survey also included consumers from the silent generation (those 77 and older), the sample size was too small to include findings related to that group in the generational breakdowns.
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