COVID-19 Testing, Vaccine, and Treatment Coverage
As the COVID-19 public health emergency (PHE) concludes, coverage related to COVID-19 testing, vaccination, and treatment may be modified based upon the sunsetting of certain provisions implemented by the federal government. These provisions have set forth requirements for Medicare, Medicaid, and private payers throughout the PHE, so some beneficiaries may see changes in coverage of these services once the requirements are lifted. Below is a table detailing the expected changes to these important coverage policies for each payer type.
Coverage policies are subject to change based on individual payers and plans.
| Service | Medicare and Medicare Advantage Coverage Policy | Medicaid Coverage Policy | Private Payers Coverage Policy |
|---|---|---|---|
|
COVID-19 lab tests |
Continued coverage without cost-sharing when ordered by a health care professional |
Coverage ends September 30, 2024, after which coverage may vary by state |
Mandatory coverage ends May 11, 2023, but may continue if plans choose to continue to include it |
|
COVID-19 at-home tests |
Coverage ends May 11, 2023 |
Coverage ends September 30, 2024, after which coverage may vary by state |
Mandatory group and individual health insurance plan coverage ends May 11, 2023 |
|
Vaccines and boosters |
COVID-19 vaccines will be covered without cost-sharing |
Coverage for all COVID-19 vaccinations without a copay or cost-sharing ends September 30, 2024; ACIP-recommended vaccines will be covered for most beneficiaries thereafter |
Individual private payers will determine specific coverage policies for these vaccinations beginning in late summer or early fall 2023 |
|
Treatment |
No cost for monoclonal antibody treatment through the end of 2023; beginning in 2024, monoclonal antibody treatments will be covered for patients experiencing COVID-19 symptoms |
Coverage for all pharmaceutical treatments with no cost-sharing will end September 30, 2024; afterward, treatments will still be covered, but states may impose usage limits or cost-sharing measures |
Potential changes include slight increases on premiums as government-purchased treatments are exhausted and private payers bear more of the cost of these medications and cost-sharing liability for COVID-19 therapeutics |
Resources for Patients
CMS Consumer Fact Sheets on Updates to Coverage for COVID-19 Tests: