The national COVID-19 Public Health Emergency is scheduled to end on May 11, 2023.
What does that mean for your health insurance coverage? Here is what to expect with regard to COVID-19 Testing, Vaccinations, and Treatments.
COVID-19 TESTING:
- Private health insurance plans will no longer be required by federal law to cover over-the-counter and laboratory-based COVID-19 tests with no cost sharing.
- That means that after May 11, coverage for COVID-19 testing under private health insurance plan are likely to change, depending on which health plan you have.
o It is very unlikely that your health insurance will cover over-the-counter COVID-19 tests.
o However, most health insurance plans do cover lab testing for illnesses, which would include testing for COVID-19. - Covered COVID-19 testing may be subject to the same cost-sharing, limits, or prior authorization requirements that apply to other types of lab tests.
- Your insurer may require you to obtain your COVID-19 test from an in-network lab or provider or may limit the amount it pays if you are tested at an out-of-network lab or provider. This means, that in most circumstances, you will be responsible for testing costs that are more than what your insurer has agreed to pay if you go to an out-of-network testing location.
- Even though federal requirements are ending, some health insurers changed the language in their policy forms to include some of the federal requirements. Health insurers that did that have to honor the contract language, even though the federal law has changed. It is important that you (or your provider/lab) check with your insurer to verify your coverage before you have the test. If you are not sure about coverage or have questions, check with your insurance company by calling the number of the back of your insurance card.
- Until the end of May 2023, individuals can continue to order tests for free from the federal government through COVIDTests.gov.
COVID-19 VACCINATIONS:
- You will still be able to get free COVID-19 vaccines from an in-network provider, including participating pharmacies. The end of the public health emergency does not change that.
- However, federal law will no longer require insurance companies to cover COVID-19 vaccines from an out-of-network provider.
- Even though the federal requirement is ending, some health insurers changed the language in their policy forms to include some of the federal requirements. Health insurers that did that have to honor the contract language, even though the federal law has changed. If you are not sure about coverage or have questions, check with your insurance company by calling the number of the back of your insurance card.
COVID-19 TREATMENTS:
- Legally, coverage for COVID-19 treatments will not change. If the COVID-19 treatment currently requires cost sharing or paying a deductible, that will continue to apply after the COVID-19 PHE ends.
- Practically, some health insurers did not apply co-pays or deductibles to COVID-19 treatments during the PHE. Those voluntary practices are likely to end with the end of the PHE.
- The federal government still has supplies of certain COVID-19 therapeutics such as Paxlovid, that it will continue to make available to providers at no cost for a period of time. Federally acquired therapeutics have to be provided at no out-of-pocket cost to patients, regardless of their insurance status.
- Health insurers will be required to cover FDA approved or authorized COVID-19 treatments, including Paxlovid and molnupiravir (Lagevrio) under the standard terms of their health insurance plans. You or your provider should check with your insurer about coverage and cost sharing (co-pays and deductibles) for these treatments. If you are not sure about coverage or have questions, check with your insurance company by calling the number of the back of your insurance card.
IMPORTANT: Some health insurers changed the language in their policy forms to include some of the federal requirements. Health insurers that did that have to honor the contract language, even though the federal law has changed. If you are not sure about coverage or have questions, check with your insurance company by calling the number of the back of your insurance card.
This information applies to private health insurance plans. It does not apply to Medicare, Medicare Advantage, Medicaid, or self-funded health plans sponsored by an employer (including government plans). If you are not sure what kind of plan you have, look at your insurance card. If it has “MIA” (for “Maryland Insurance Administration”) on it, that means it is private health insurance. If it does not have “MIA” check by calling the number of the back of your insurance card.
If you have any questions or concerns about your insurance coverage, the Maryland Insurance Administration is a free resource. Call us at 1-800-492-6116.
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