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Here's everything you need to know about getting a COVID-19 test in New Hampshire

nevins covid testing
Alli Fam, NHPR
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After a long hunt for over-the-counter COVID-19 tests, Matthias Nevins found antigen tests at a Concord Walgreens. Nevins bought two boxes, each with two rapid antigen tests. The four tests cost just him just under $50. Nevins, fully vaccinated, wanted a test before visiting family in Vermont.

With the delta variant driven surge in COVID-19 cases ongoing, and many unvaccinated kids back in classrooms, the demand for COVID-19 tests has shot up across the state, putting a strain on many health providers.

As breakthrough cases also become more common (but still very low compared to COVID cases among unvaccinated people), some vaccinated people are also looking for tests.

Get NHPR's reporting about politics, the pandemic, and other top stories in your inbox — sign up for our newsletter today.

Knowing what type of test to get, finding one and knowing how much it will cost can be complicated. But we're here for you.

Where can I get tested in New Hampshire?

The Department of Health and Human Services has a list of testing providers across the state here.

You should plan ahead, because you may have to book in advance to find a time. Plus, getting an appointment outside of regular business hours can be tricky, though many providers do offer testing on the weekends.

Is it easy to get a COVID test in the Granite State right now?

There are a lot of places to get tested. But you have to plan ahead, because it’s not always easy to get results quickly, or close to home, or during hours that fit your schedule.

PCR tests take time because the sample has to be sent to a lab. You’ll often get a result in 1-2 days, but it could be longer.

While the results of antigen tests are immediate, the tests can be hard to find on short notice due to a national shortage.

But we recommend calling pharmacies to ask when they get their shipments, which can help you secure an over-the-counter test if you are trying to buy one over the counter.

After closing its public testing sites earlier this year, the state recently announced it will be opening 4 new sites, offering PCR tests.

Earlier in the summer, some New Hampshire testing providers wound down their testing operations, reducing hours and availability. Now, they have to scale up again.

Is it still free to get a COVID test here?

The short answer is yes. Long answer? Sometimes.

Free testing will continue at least as long as the federal public health emergency remains in place. But that doesn’t mean your test will always be free.

Part of that free testing comes down to interpretation by different New Hampshire. insurers and plans. There’s a lot of grey area, so the best way to know is to talk to your insurance provider.

Okay, I’ll call my insurer. But when should my test clearly be free? 

The test should always be at no cost to you when the test is deemed medically necessary by a care provider.

The New Hampshire Department of Insurance says when it comes to COVID-19 testing, “medically necessary” means the test is being requested because of any COVID-19 symptoms, regardless of how severe, or exposure to another person who has tested positive.

So, if, for example, you aren’t sure if you’ve got a mild cold or mild case of COVID-19, and want to get tested, that would be covered.

Or if you were having dinner with friends, later to find out one of your friends tested positive, and you want to get tested, that would also be covered.

I don’t have insurance. Can I still get a free test? 

Yes. If you don’t have insurance you can access free testing through N.H. Easy Medicaid Limited Testing Benefit. The coverage can be applied retroactively.

A spokesperson for the New Hampshire Department of Health and Human Services says community testing hospitals have been trained on this program.

Additionally, there are federal funds providers can use when providing a test to an uninsured client.

When could I have to pay for my COVID-19 test? 

If you're getting testing for the workplace, per federal law, that type of testing does not need to be covered by your insurance.

For example, if your employer requires you either need to be vaccinated or get tested weekly, and you choose to get weekly testing, your insurance provider is not required to cover those tests.

More Granite Staters may begin to pay for this type of testing when the federal vaccine or weekly testing requirement starts for businesses with 100 or more employees.

If you choose to buy an over-the-counter COVID-19 test, it may be difficult to get it covered, says Sabrina Corlette, a research professor at Georgetown University who has studied COVID-19 testing costs. Corlette says it’s because you’ve made the decision to purchase the test, not a health care provider.

If you're getting a test to stay safe while traveling, or going to a concert, or when you’re around unvaccinated kids the New Hampshire Department of Insurance also says that type of “recreational” testing does not need to be covered.

Testing for surveillance purposes, like large-scale asymptomatic testing to monitor COVID-19 rates in different communities, per federal law does not need to be covered by insurers.

You just said asymptomatic surveillance testing is not covered, but my kid is a part of a Safer at School Screening (SASS) screening program. That’s free right? 

Yes. The state covers asymptomatic screening testing for specific populations, including for any school or youth camp that wants testing and for people who are in long-term care. The state has a program to support schools that opt to conduct screening testing, the Safer at School Screening program, funded through federal money.

If I decide to pay for a test, how much will it cost? 

That depends on where you purchase your test and what type of test you buy.

CVS and ClearChoiceMD Urgent Care offer PCR testing for $139. ConvenientMD Urgent Care has tests for $175. ClearChoiceMD Urgent Care also has antigen testing for $214.

Over-the-counter testing is also available at many pharmacies and online, although supply is limited.

Walmart sells antigen tests that come in packs of two for $14. As of Oct. 6, the tests are sold out online, but some may be still available on shelves. Other pharmacy locations across the state sell similar antigen testing kits, but the cost is likely higher, closer to $25.

PCR testing is available on Amazon for $36.99. You can do the test yourself, but the results must be read by a lab. The cost includes prepaid next-day shipping to the lab.

You’ve said testing is covered when ordered by a provider. Who counts as a provider? What if I don’t have a primary care provider?

Health care providers can include a doctor, a pharmacist, or medical staff at an urgent care clinic.

You don’t need to have a primary care provider for a provider to order a test on your behalf or for one to be covered. If you’re booking a test online at a pharmacy, for example, that “provider order” from the pharmacy, would be based on the questionnaire you fill out online when you schedule your appointment, where you may answer questions about COVID-19 symptoms and exposure.

If you are going through your doctor, you might have a quick appointment to determine the need for a COVID-19 test which they may then order for you.

Some New Hampshire hospitals and health centers prioritize testing for patients who have had a doctor order a test. If you want one for something like travel, these facilities may suggest going to a local pharmacy instead.

How are providers actually deciding when to “order” a test or not? How are they determining if it is “medically necessary”? 

This is complicated. For providers, who are the ones ultimately choosing to officially order the test or not, the process has its own set of snags and confusion.

Dr. Mark Pundt, president and CMO of Convenient MD says that as a provider, ConvenientMD is trying to navigate policies of different insurance companies when it comes to ordering a test and determining if it is medically necessary.

Sometimes, he says it's clear cut when the patient would pay outright, like domestic travel, other times, he says, it’s more gray.

If a provider doesn’t “order” the test, that doesn’t mean you can’t get one, it just means that you may have to pay for it yourself. We talked to some common New Hampshire insurers about what you can expect.

A spokesperson for Anthem Blue Cross and Blue Shield in New Hampshire says they cover testing as long as it is ordered by a provider.

A spokesperson for Harvard Pilgrim says COVID-19 tests will only be covered or reimbursed if they are medically necessary, as determined by a health care provider and that Harvard Pilgrim, as the insurer, are not the ones determining if the test is medically necessary or not.

A spokesperson for the Department of Health and Human Services says New Hampshire Medicaid will pay for any test submitted to the program by providers.

If I ask for a COVID-19 test, but my provider also wants to test for other illnesses, is that covered too? 

This would depend on your insurance plan. But it’s something to watch out for. Tests for other illnesses do not fall under the laws around free COVID-19 testing.

I’ve heard PCR tests are more accurate. Should I trust results from an antigen test? 

PCR, or polymerase chain reaction, testing is more sensitive than antigen, or rapid, testing. Antigen testing can give more false negatives, especially among asymptomatic people.

But Dr. David Itkin, an infectious disease specialist at Portsmouth Regional Hospital, says the effectiveness of an antigen test is also about timing. If you’re getting tested when you’re symptomatic for the virus, Itkin says, that’s when an antigen test is most reliable and comparable to a PCR test.

If you’re getting tested soon after an exposure, even before symptoms may develop, PCR is the more reliable option.

For frequent testing for communities, like weekly school testing of nursing home staff and residents, antigen testing is also very effective.

Itkin says the high sensitivity of PCR testing also has its downsides. People can test positive for the virus weeks after they are no longer contagious.

When might I want to get an antibody test? 

Dr. Itkin says that generally, antibody tests have limited clinical value, although they can be useful in determining if someone previously had a COVID-19 infection.

Antibody testing is not recommended for determining if you have “responded” to the vaccine or to evaluate your COVID-19 immunity. Itkin says antibody testing has not been studied enough or standardized in that scenario. The FDA has advised against the use of antibody testing that way.

Is over the counter testing okay? Or should I get it done by a health care provider? 

Most over-the-counter testing right now is antigen testing, which for asymptomatic patients especially, is less accurate.

But, accuracy of the results also comes down to good swabbing technique. So, if you're administering one at home, make sure to swab properly, which may feel unpleasant.