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Marketplace coverage & COVID-19

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:
Get the updated 2024-2025 COVID-19 vaccine
If you’re 6 months or older, getting the updated COVID-19 vaccine each year helps:
  • Protect you from currently circulating strains
  • Prevent serious complications and hospital visits
Find COVID-19 vaccines
All Marketplace plans currently cover the updated 2024-2025 COVID-19 vaccine formula. You’re up to date with COVID-19 vaccines when you get any of these vaccines:

2024-2025 Moderna

  • Anyone 5 years or older: 1 shot
  • Children 6 months through 4 years: 1-2 shots, depending on the number of previous Moderna shots

2024-2025 Pfizer-BioNTech

  • Anyone 5 years or older: 1 shot
  • Children 6 months through 4 years: 1-3 shots, depending on the number of previous Pfizer-BioNTech shots

2024-2025 Novavax

Anyone 12 years or older who has:
  • Already had a COVID-19 vaccine: 1 shot
  • Never had any COVID-19 vaccine: 2 shots

If you’re immunocompromised

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. Talk to your health care provider to find out if you should get additional shots of the updated vaccine.

If you recently had COVID-19

  • It’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
Stay up to date with vaccine recommendations 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 find out 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 charges 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.
If you think your provider incorrectly charged you for the COVID-19 vaccine, ask them for a refund. If you think your provider charged you for an office visit or other fee, but the only service you got was a COVID-19 vaccine, report them to the Office of the Inspector General, U.S. Department of Health and Human Services. Call 1-800-HHS-TIPS or visit OIG.HHS.gov/fraud/report-fraud.

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
Call your health insurance plan for more details.

Protect yourself from scams

Don’t share your personal or financial information if someone calls you promising free at-home tests.

Have “expired” at-home COVID-19 tests?

Check extended expiration dates before you throw your unused tests away.

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/covid has the latest public health and safety information.
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