Your costs for Covid tests and treatments may rise after the public health emergency ends
Most people can expect to pay more for Covid tests after the federal public health emergency expires at the end of the day Thursday.
The emergency declaration guaranteed widespread access to free Covid-related health services starting in January 2020.
But once it ends, people with employer-based private health insurance could start paying for at-home Covid tests as well as rapid or lab tests at a doctor’s office or clinic. Several large insurance companies — including UnitedHealthcare, Cigna and Aetna — have said their coverage of at-home tests, which cost about $11 on average, will end on Thursday.
In California, however, residents will have continued access to free tests, vaccines and treatments given by licensed health care providers through Nov. 11.
Additionally, the U.S. government is distributing free at-home tests from the national stockpile through the end of the month. The Department of Health and Human Services said Tuesday that the government could decide to ship more tests in the future depending on supply.
Federally purchased doses of Paxlovid — the go-to treatment for people at risk of severe disease — could also remain free as long as supply lasts, according to KFF, a nonprofit health think tank.
Here are the expected changes to Covid-related costs.
Tests will get more expensive
- For people with private insurance: Insurers will no longer pay for up to eight free at-home tests per month. Rapid or laboratory tests ordered or administered by a clinician will be fully covered but subject to an individual’s plan, so people may be responsible for paying deductibles or copays. Insurers could also limit the number of tests covered per person or require a prior authorization process.
- For those on Medicare: People will no longer get up to eight at-home Covid tests per month covered, but lab tests ordered by a doctor or other health care provider won’t cost anything out-of-pocket. Some people with Medicare Advantage may continue to get coverage for at-home tests depending on their plans, but they may incur costs for PCR or antigen tests.
- For those on Medicaid: States must provide coverage for Covid tests of all kinds through Sept. 30, 2024. After that, coverage may vary by state.
- For people without insurance: During the public health emergency, 18 states and U.S. territories covered the costs of Covid tests for people without insurance through Medicaid. That ends on Thursday, though people who are uninsured may still be able to find free testing through some community clinics.
Vaccines will largely remain covered
- Private insurance: Vaccines and boosters will still be covered if administered by an in-network health care provider. People might be charged, however, if they are vaccinated by an out-of-network provider.
- Medicare: Vaccines will remain covered if a patient’s doctor or health care provider agrees to be paid directly by Medicare. Those with Medicare Advantage won’t be charged, either, if they use an in-network provider.
- Medicaid: States must provide coverage without cost sharing through Sept. 30, 2024. After that, Medicaid will likely continue to cover the cost of vaccines.
- No insurance: Medicaid coverage for vaccines will end in 18 states and U.S. territories, but an HHS program will make sure vaccines remain free to those who are uninsured.
Treatment costs will vary by insurance type
- Private insurance: The federal government ordered and paid for a stockpile of Paxlovid, so many patients have until now gotten the antiviral for free, regardless of their insurance type. That will remain true as long as the stockpile lasts, but after that, Paxlovid costs will be subject to an individual’s insurance plan, so people may incur copays or out-of-pocket expenses. Insurers are not required to waive out-of-pocket costs for Covid treatment such as antiviral pills, doctors’ visits or in-hospital care. Some did so voluntarily during the public health emergency, though most insurers stopped covering treatment costs by 2021.
- Medicare: Deductibles and out-of-pocket costs for treatment will stay the same for people with traditional Medicare, but Medicare Advantage may require patients to see in-network providers in order to get treatment covered. Paxlovid will remain free as long as the federal supply lasts, though people with Medicare Part D can get the drug at no out-of-pocket cost through December 2024.
- Medicaid: States must provide coverage for Covid treatment through Sept. 30, 2024. After that, coverage may vary by state.
- No insurance: Medicaid coverage for tests will end in 18 states and U.S. territories, but HHS will make sure people who are uninsured don’t pay out-of-pocket for certain drugs like Paxlovid or Lagevrio (another oral antiviral). People may still be responsible for hospital fees or doctors’ visits to obtain treatment, however.