Alyssa Lane
The COVID-19 pandemic has brought to the fore the importance of medical insurance in covering the costs of testing, treatment, and vaccination. In the United States, the Coronavirus Aid, Relief, and Economic Security (CARES) Act, which expired on September 30, 2021, previously ensured that Medicare beneficiaries could access COVID-19 vaccines with no cost-sharing. While the public health emergency has ended, most Americans continue to have access to zero-cost COVID-19 vaccines, and health insurance plans are required to cover the costs of the vaccine, even if administered by an out-of-network provider. However, it is important to note that American health insurance coverage can vary, and some plans may require the use of in-network providers for cost-free vaccination. Additionally, health plans may only cover the costs of testing when deemed medically necessary or ordered by a doctor.
| Characteristics | Values |
|---|---|
| Does medical insurance cover coronavirus? | It depends on the insurance plan |
| Does Medicare cover coronavirus? | Yes, Medicare covers the Moderna, Pfizer-BioNTech, or Novavax COVID-19 vaccine for anyone who has Medicare. |
| Does Medicaid cover coronavirus? | Yes, Medicaid covers the COVID-19 vaccine for children under 19 and adults. |
| Do employer-sponsored health plans cover coronavirus? | Yes, employer-sponsored health plans are required to cover the coronavirus vaccine without cost-sharing. |
| Do individual health plans cover coronavirus? | Yes, individual health plans are required to cover the coronavirus vaccine without cost-sharing. |
| Are coronavirus tests covered by insurance? | It depends on the insurance plan. Some insurance plans may only cover coronavirus tests when they are deemed medically necessary or ordered by a doctor. |
| Are coronavirus treatments covered by insurance? | It depends on the insurance plan. Some insurance plans may cover coronavirus treatments, including oral antiviral treatments and hospitalizations. |
| Are there any financial assistance programs available for coronavirus testing and treatment? | Yes, there are financial assistance programs available, such as the Provider Relief Fund and the COVID-19 Coverage Assistance Fund, which help cover the costs of testing, treatment, and vaccine administration for uninsured or underinsured individuals. |
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What You'll Learn
COVID-19 vaccines
During the public health emergency, private health insurance plans were required to cover all the costs of a COVID-19 vaccine even if it was administered out-of-network. The American Rescue Plan and Inflation Reduction Act ensure that full coverage of COVID-19 vaccines continues for Medicaid enrollees, and Medicare beneficiaries can also access COVID-19 vaccines at no cost. Medicare Part D plans make all adult vaccines recommended by the Advisory Committee on Immunization Practice available at no cost.
Medicare covers the updated (2024-2025 formula) Moderna, Pfizer-BioNTech, or Novavax COVID-19 vaccine for anyone who has Medicare. If you have Medicare and have a disability or face other challenges in getting to a location away from home for a vaccination, Medicare will pay a doctor or other care provider to give you the COVID-19 vaccine in your home.
For those without health insurance, there will be a limited number of 2024-2025 COVID-19 vaccine doses available through state health department immunization programs.
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Testing and treatment
During the COVID public health emergency, most plans were required to cover the full cost of testing, including lab-based and at-home testing. But that is no longer the case. So, coverage of at-home COVID tests is now optional for health plans other than Medicaid. The CARES Act requires all non-grandfathered health plans, including private insurance, Medicare, and Medicaid, to cover COVID-19 vaccines and antibody testing without any cost-sharing for the member. Dozens of insurers, including major ones such as Aetna, Cigna, and Humana, have waived co-payments, co-insurance, and deductibles for all COVID-19 treatments, including hospital stays.
Comprehensive major medical plans generally cover all medically necessary inpatient and outpatient care for COVID-19 (or long COVID). However, "cover" does not mean they will pay for all of it. Patients' cost-sharing comes into play here. Under the ACA, all non-grandfathered, non-grandmothered health plans must have in-network out-of-pocket maximums that don't exceed a certain amount for a single individual in a given year. For example, this maximum was $9,100 in 2023 and $9,450 in 2024. So, for most patients with comprehensive major medical coverage who needed COVID treatment in 2023, out-of-pocket costs won't exceed $9,100 as long as they stay in-network.
If you are uninsured, you can enroll in a plan through the health insurance marketplace (exchange) in your state during open enrollment, which runs from November 1 to January 15 in most states. You can also enroll if you have a qualifying life event, such as the low-income special enrollment period or the loss-of-Medicaid special enrollment period in many states. Additionally, if your employer offers a flexible spending account (FSA) and you have opted into it, you can use it for out-of-pocket COVID treatment expenses.
Testing is free through public healthcare providers in some countries. In addition, coronavirus testing may be covered under some travel insurance policies if the policyholder has coronavirus symptoms and the test is performed based on a doctor's or nurse's referral.
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Medicare and Medicaid
Medicare will cover coronavirus testing for current infection swab tests and serology testing to determine whether antibodies for the virus are present in the blood. These tests are covered under Medicare Part B. If you have a Medicare Advantage Plan, this testing will be covered as well because MA plans must cover all Part A and Part B services. For most services or diagnostic tests, recipients are responsible for paying towards their Part B deductible and a 20% coinsurance payment. However, the Families First Coronavirus Response Act has also eliminated any associated out-of-pocket testing costs for recipients.
Medicare Part B covers molecular, antigen, and antibody diagnostic tests for COVID-19 when ordered by your doctor and when done in a Medicare-approved lab. Medicare Part B also covers ambulance rides or physician visits. If your treatment requires admission to the hospital, your treatment will be covered under Medicare Part A.
Medicare Part D covers oral antiviral treatment. Your plan's deductible, copayment, and coinsurance rules apply. Medicare Part D also covers FDA-authorized COVID-19 antibody tests if you were diagnosed with a known current or known prior COVID-19 infection or suspected current or suspected past COVID-19 infection. Monoclonal antibody treatments for COVID-19 are also covered under Medicare Part D. All medically necessary hospitalizations are covered under Medicare Part D, including if you're diagnosed with COVID-19 and might otherwise have been discharged from the hospital after an inpatient stay, but instead you need to stay in the hospital under quarantine. You’ll still pay for any hospital deductibles, copays, or coinsurance that apply.
Medicare covers the updated (2024–2025 formula) Moderna, Pfizer-BioNTech, or Novavax COVID-19 vaccine for anyone who has Medicare. If you have Medicare and have a disability or face other challenges in getting to a location away from home for a vaccination, Medicare will pay a doctor or other care provider to give you the COVID-19 vaccine in your home. You pay nothing when you get the vaccine from an in-network provider.
Medicaid provides health insurance coverage to 75.5 million low-income Americans. Medicaid coverage for vaccines varies based on age, eligibility pathway, and state. Vaccines are an optional benefit for certain adult populations, including low-income parents/caretakers, pregnant women, and persons who are eligible based on old age or a disability. For adults enrolled under the ACA’s Medicaid expansion and other populations for whom the state elects to provide an “alternative benefit plan,” their benefits are subject to certain requirements in the ACA, including coverage of ACIP-recommended vaccines with no cost sharing. There are separate coverage requirements for the COVID-19 vaccine during the time that states are receiving enhanced federal matching funds under the Families First Coronavirus Response Act. Children under age 19 are eligible for the VFC program if they are Medicaid-eligible, uninsured, or American Indian or Alaska Native. Children get vaccines for free through the VFC program, but participating health care providers can charge for other services including administering vaccines and office visits.
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Private insurance
Private health insurance plans will be required to cover all the costs of a COVID-19 vaccine, even if an out-of-network provider administers it. The CARES Act requires that employer-sponsored and individual health plans subject to the ACA's preventive services standards cover a coronavirus vaccine without cost-sharing 15 days after it is recommended by ACIP. However, it should be noted that the guarantee is tied to the ACA provision requiring private insurers to cover vaccines, so it could be voided if the Supreme Court overturns the ACA.
The two most commonly used vaccines in the US (Pfizer/BioNTech and Moderna) have full use authorization and are covered fully by Medicare. The updated 2024–2025 Pfizer-BioNTech or Moderna vaccine is available for people 5 and older. The updated Novavax vaccine is available for people 12 and older. Medicare Part B covers COVID-19 diagnostic tests without cost-sharing when ordered by a healthcare provider and done by a laboratory. Medicare Part D covers oral antiviral treatment, and monoclonal antibody treatments for COVID-19. All medically necessary hospitalizations are also covered by Medicare Part D.
Medicaid coverage for vaccines varies based on age, eligibility pathway, and state. Vaccines are an optional benefit for certain adult populations, including low-income parents/caretakers, pregnant women, and persons eligible based on old age or disability. Children under age 19 are eligible for the VFC program if they are Medicaid-eligible, uninsured, or American Indian or Alaska Native.
It is important to learn and understand the specifics of your health insurance plan.
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Cost-sharing
Medicare
Medicare Part B covers the cost of COVID-19 diagnostic tests approved by the Food and Drug Administration (FDA), with no out-of-pocket costs for beneficiaries. Medicare Part A covers medically necessary hospitalizations due to COVID-19, but beneficiaries will still pay for any hospital deductibles, copays, or coinsurance that apply. Additionally, some Medicare Advantage Plans (Part C) may require beneficiaries to pay a portion of the cost for COVID-19-related services.
Medicaid
Medicaid coverage for COVID-19 vaccines, testing, and treatment varies based on age, eligibility pathway, and state. Vaccines are an optional benefit for certain adult populations, including low-income parents/caretakers, pregnant women, and persons eligible based on old age or disability. During the PHE, states received enhanced federal matching funds for Medicaid coverage of COVID-19-related services, but this additional funding has since expired.
Private Insurance
Most private health insurance plans now determine coverage for COVID-19 testing and treatment based on medical necessity, provider networks, and plan type. Employer-sponsored and marketplace policies often follow Affordable Care Act (ACA) guidelines, which may require coverage for diagnostic testing when ordered by a healthcare provider. However, routine screening for work, travel, or personal reassurance is generally not covered unless explicitly stated in the policy.
Health Care Sharing Ministries
Health care sharing ministries, such as Liberty HealthShare, typically require members to meet their normal "annual unshared amount" (similar to a health insurance deductible) before sharing the cost of the COVID-19 vaccine. These plans are not required to cover COVID-19 vaccines at zero cost, but they can require members to obtain vaccines in-network to have zero cost-sharing.
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Frequently asked questions
Yes, most health insurance plans cover the COVID-19 vaccine. However, some plans require members to get their COVID-19 vaccines in-network for zero cost-sharing.
Congress required health plans to fully cover COVID-19 testing. However, insurance companies are arguing that they should only pay if patients show symptoms or if the tests are ordered by a doctor.
Medicare Part D covers oral antiviral treatment, but your plan's deductible, copayment, and coinsurance rules apply.
Medicare covers all medically necessary hospitalizations. This includes if you're diagnosed with COVID-19 and might otherwise have been discharged from the hospital but instead need to stay in the hospital under quarantine. You’ll still pay for any hospital deductibles, copays, or coinsurance that apply.
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