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Marketplace coverage & Coronavirus

Notice:
Coverage changes for COVID-19
The Public Health Emergency for COVID-19 ended on May 11, 2023.
Your Marketplace plan might have made some changes to how it covers services for COVIDโ€‘19.
  • Vaccines continue to be free of charge when delivered by an in-network provider.
  • Some plans might not cover COVID-19 tests.
  • If you can't pay your premiums, plans won't delay ending your coverage.
Keep reading to learn more about these changes and your coverage options.
All Marketplace plans generally cover the diagnosis and treatment of COVID-19.
  • Discover what Marketplace plans cover. All Marketplace plans cover treatment for pre-existing medical conditions and canโ€™t terminate coverage due to a change in health status, including diagnosis or treatment of COVID-19.
  • Check with your health insurance company for their specific benefits and coverage policy.

COVID-19 vaccines

Notice:
Vaccines to prevent COVID-19ย are:
  • Safe and effective
  • Free of charge if you're enrolled in a Marketplace plan when delivered by an in-network providerย 
  • Widely available โ€”ย anyone 6 months or olderย can get a COVID-19 vaccine
All Marketplace plans currently cover the updated 2023-2024 COVID-19 vaccine formula.

If you've never had a COVID-19 vaccine

  • Anyone 5 years or older who's unvaccinated can get 1 shot of the updated vaccine.
  • Children 6 months through 4 years of age who are unvaccinated can get either:
    • 2 shots of the updated Moderna vaccine
    • 3 shots of the updated Pfizer-BioNTech vaccine

If you've already had at least 1 shot of the COVID-19 vaccine

  • Anyone 5 years or older can get 1 shot of the updated COVID-19 vaccine, at least 2 months after getting the last shot of any COVID-19 vaccine.
  • Most people who are moderately to severely immunocompromised (like if you had an organ transplant and are at risk for infections and other diseases) may get additional shots of the updated COVID-19 vaccine. Your health care provider can determine if and when you should get additional shots of the updated vaccine.
  • Children 6 months through 4 years who got COVID-19 vaccines before September 12, 2023, should get 1 or 2 shots of the updated COVID-19 vaccine. The number of shots from the updated COVID-19 vaccine they can get depends on the vaccine and the number of shots already received.
Note: Some adults 18 years and older who have completed their primary vaccine series have the option to get a Novavax vaccine instead of the updated Pfizer-BioNTech or Moderna COVID-19 vaccine.ย 

If you recently had COVID-19

  • Itโ€™s still important to stay up to date with your vaccines. Talk with your health care provider about what timing is right for you.
  • Decide if you want to delay getting the updated COVID-19 vaccine by 3 months. Getting COVID-19 again is less likely in the weeks to months after you had COVID-19, but there are certain reasons why you may want to get the updated COVID-19 vaccine sooner than 3 months, like:
    • Your personal risk of severe disease
    • Risk of disease in a household member or close contact
    • Local COVID-19 hospital admission level
    • The most common COVID-19 variant currently causing illness

If you paid to get a COVID-19 vaccine

If you get other medical services at the same time you get the COVID-19 vaccine, you may owe a copayment or deductible for those services.
If you paid a fee or got a bill for a COVID-19 vaccine, check this list to see if your provider should have charged you:
  • Check receipts and statements for any mistakes.
  • Check if your provider is in-network with your health insurance plan. Plans only have to cover the full cost of the vaccine if you get it from an in-network provider.
  • Call your provider's office to ask about any changes you think are incorrect. They may help you better understand the services you got, or realize they made a billing error.
  • Review your โ€œExplanation of Benefits.โ€ Report anything suspicious to your insurer.

COVID-19 diagnostic testing

Some Marketplace plans might not cover:
  • COVID-19 diagnostic tests done at a doctorโ€™s office or other health care provider
  • At home COVID-19 tests you buy online or at a pharmacy or store
But, Marketplace plans must cover all applicable COVID-19 diagnostic tests as long as they were ordered or bought before May 12, 2023, even if the claim is processed after May 11, 2023.
Call your health insurance plan for more details.

If you need medical care

Call before going to the doctor. You may be asked to do the following to lower exposure risk and protect others:
  • Wait in your car until the start of the visit
  • Use a limited entrance
  • Be screened for COVID-19 by having your temperature checked
  • Avoid waiting rooms and areas
  • Maintain social distancing
  • Wear a face covering, which will be provided to you if you donโ€™t have your own
  • Wash your hands or use hand sanitizer
If youโ€™re sick with COVID-19 or think you may have it,ย visit CDC.gov for steps to help prevent the spread. If you needย emergency care, you should go to the closest hospital that can help you.
Generally, Marketplace plans continue to cover COVID-19 treatments. If your plan has deductibles, copayments, or coinsurance for these services, you'll still pay those.

For the latest COVID-19 information

CDC.gov/coronavirusย has the latest public health and safety information from CDC and for the overarching medical and health provider community on COVID-19.