Insurance Coverage and COVID-19

In most cases, yes. As of February 4, Medicare will cover diagnostic testing for COVID-19 with no cost-sharing if ordered by a healthcare provider. Medicaid, the Children’s Health Insurance Program (CHIP) and most private insurance plans (including employer-sponsored plans and marketplace plans) are required to cover diagnostic testing for COVID-19 without any cost-sharing starting March 18, 2020 and continuing through the end of the federally declared public health emergency. However, certain skimpy healthcare plans – like short-term plans, farm bureau plans and health ministry plans – do not have to cover this testing. Additionally, some plans have begun to establish certain limitations. For example, testing might not be covered if it is not intended for diagnostic purposes, but, rather, to show you do not have COVID-19 in order to travel or return to work.

Antibody tests can help to determine if a person was previously infected with a virus, even in individuals who never had any symptoms of the disease. According to the Centers for Disease Control and Prevention (CDC), we do not know if antibodies protect someone from reinfection.¹ Learn more about testing for COVID-19 here.

The requirements for insurance coverage of antibody testing are the same as the requirements for diagnostic testing above—so in most cases, if ordered by a healthcare provider, antibody testing must be covered for patients without cost-sharing as well.

Treatment for COVID-19 could include doctors' visits, hospitalizations, prescription medications and other medical services. Coverage for and the cost of these services will depend on your individual health insurance plan. Some private insurance plans have voluntarily agreed to waive costs for COVID-19 treatment, but the services included, length of time and other key details vary from plan to plan. State Medicaid and CHIP plans must cover COVID-19 treatment without cost-sharing through the end of the federally declared public health emergency in order to qualify for extra financial support from the federal government.

You may have seen media reports of patients receiving surprise bills related to COVID-19 treatment. Surprise medical bills can occur when a patient inadvertently receives care from an out-of-network provider. According to instructions issued to healthcare providers, providers who receive extra support from the federal government should not charge presumptive or actual COVID-19 patients more for receiving care out-of-network related to COVID-19, but patients should look closely at any bills they receive for COVID-19 related care.

A vaccine against COVID-19 is not yet available. As soon as a vaccine is approved by CDC’s Advisory Committee on Immunization Practices, most private health plans will be required to cover the vaccine without cost-sharing. Medicare will cover a licensed vaccine without cost-sharing as well. Medicaid programs will likely cover the vaccine, but for those in the traditional Medicaid population, the ultimate determination will be left to the states. Additionally, as with testing, skimpy health plans like short-term plans are not required to cover a vaccine.

The federal government will cover 100 percent of the costs for states to cover COVID-19 testing for the uninsured through their Medicaid programs.²

COVID-19 has made access to quality and affordable healthcare more important than ever. If you are uninsured and looking to enroll in healthcare coverage, check out our guide to see what options are available and help you through the enrollment process. Depending on your income, you may qualify for financial assistance for coverage.

The American Lung Association is advocating for Congress to take additional action to ensure patients have access to the quality and affordable health coverage during this critical time. This includes:

• Reopening Healthcare.gov so more individuals who are uninsured can sign up for quality and affordable healthcare coverage.
• Improving the affordability of COBRA coverage for individuals who are furloughed or laid off.
• Increasing funding for state Medicaid programs to provide coverage to low-income Americans during the COVID-19 public health emergency and its aftermath.
• Requiring coverage of COVID-19 testing, treatment and, when available, a vaccine at no cost to patients, regardless of the type of health insurance they have; and 
• Permanently protecting patients from surprise medical bills.