• COVID-19 Home Antigen Request Form

    Medicare and Most insurance companies will allow Covid-19 home antigen test to be billed out and provided FREE to you. Maggy Pharmacy is a participating pharmacy in the Medicare Over-The-Counter (OTC) tests initiative. Maggy Pharmacy will bill Medicare or Private Insurance on your behalf for Covid-19 Home Antigen Tests. Medicare covers a Max of 8 Home Tests every 30 days if needed. You may request less. Most private insurance companies, but not all, will cover Covid-19 Home Antigen tests. Quantities allowed may vary.
  • Please use this form to fill out a request for FREE Covid-19 Home Antigen Tests.  This form will allow us to bill Medicare or your prescription insurance company on your behalf. Maggy Pharmacy will notify you if more information is needed or what is allowed by your insurance.

    Most insurances will cover the costs of the Home Antigent Tests with NO out of pocket costs.  Some insurances may not cover these tests.  Maggy Pharmacy will let you know if your insurace does not cover the home test you requested.

    If you are uninsured the Covid-19 Home Antigen Tests will not be covered through our pharmacy.  You may have other options in the community to receive free tests through local towns, fire departments, and governemnt agencies.

     

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  • I permit Maggy Pharmacy Inc to release and collect my health information, and other information, as required (and as permitted by the HIPAA Regulations) from my health care provider Medicare or my private insurance.

    I understand this form will be maintained and kept on file and made available to Medicare or my insurance representatives if requested.

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