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 COVID‑19.
  • Vaccines continue to be free of change 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 can’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-19 are:
  • Safe and effective
  • Free of charge if you're enrolled in a Marketplace plan when delivered by an in-network provider 
  • Widely available — anyone 6 months or older can get a COVID-19 vaccine
Find COVID-19 vaccines
All Marketplace plans currently cover the updated COVID-19 vaccine. The updated vaccine targets the original COVID-19 viral strain and 2 Omicron variants (BA.4/BA.5). The updated vaccine is available from:
  • Pfizer-BioNTech for anyone 5 years and older
  • Moderna for anyone 6 months and older

If you've never had a COVID-19 vaccine shot

  • Most people who are unvaccinated can get 1 shot of the updated vaccine, instead of multiple shots of the original COVID-19 vaccine.
  • Children 6 months through 5 years of age who are unvaccinated can get either:
    • 2 shots of the updated Moderna vaccine if they're 6 months through 5 years of age
    • 3 shots of the updated Pfizer-BioNTech vaccine if they're 6 months through 4 years of age
    • 1 shot of the updated Pfizer-BioNTech vaccine if they're 5 years of age

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

  • Most people (depending on age) who completed their primary series with the original COVID-19 vaccine but haven't received the updated vaccine, can get 1 shot.
  • Anyone 65 years or older who received 1 shot of the updated vaccine at least 4 months ago, can get a second shot.
  • Most people who are immunocompromised (like if you had an organ transplant and are at risk for infections and other diseases) and got 1 shot of the updated vaccine at least 2 months ago, can get a second shot. Your health care provider can determine if and when you should get additional shots of the updated vaccine.
  • Children 6 months through 5 years who received 1-3 shots of the original COVID-19 vaccine can get 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. Visit CDC.gov to learn more about the Novavax vaccine.
Stay up to date with COVID-19 vaccines at CDC.gov.

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 “Explanation of Benefits.” Report anything suspicious to your insurer.

COVID-19 diagnostic testing

Some Marketplace plans might not cover:
  • COVID-19 diagnostic tests done at a doctor’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 don’t have your own
  • Wash your hands or use hand sanitizer
If you’re sick with COVID-19 or think you may have it, visit CDC.gov for steps to help prevent the spread. If you need 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/coronavirus has the latest public health and safety information from CDC and for the overarching medical and health provider community on COVID-19.