Marketplace coverage & Coronavirus

If you already have coverage through the Marketplace, the rules in your Marketplace health plan for treatment for the coronavirus disease 2019 (COVID-19) emergency remain the same as any other viral infection, but your health insurance company may have added benefits.

  • See 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.
  • Log in to update your Marketplace application if COVID-19 impacts your income or household. You may be able to change your plan if certain situations apply.

COVID-19 vaccines

Vaccines to prevent COVID-19 are:

  • Safe and effective
  • Free of charge to everyone living in the United States, regardless of immigration or health insurance status
  • More widely available — anyone age 12 and older can get a COVID-19 vaccine

If you paid to get a COVID-19 vaccine

When you get a COVID-19 vaccine, your provider can’t charge you for an office visit or other fee if the vaccine is the only medical service you get. 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 the receipts and statements you get from your provider for any mistakes.
  • Call your provider’s office to ask about any charges you think are incorrect. The person you speak to 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 by calling 1-800-HHS-TIPS or visiting TIPS.HHS.GOV.

COVID-19 diagnostic testing

All Marketplace health plans cover COVID-19 diagnostic tests, even if you don’t have symptoms, or don’t know if you’ve been exposed to COVID-19. For example, if you want to make sure you’re COVID-19 negative before visiting a family member, you pay nothing to get tested.

If you need medical care

Call before going to the doctor. Many routine medical visits are being postponed, or done online or by phone. Telehealth services for non-emergency and non-COVID-19-related care may be available to you.

If you must visit in-person, 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.

If you lost your job or experienced a reduction in hours

You may qualify for a Special Enrollment Period if you experience certain life changes like:

  • You lost health coverage through your employer in the past 60 days
  • You lost health coverage through a household member’s employer in the past 60 days
  • You expect to lose coverage in the next 60 days (like if you lose health coverage through a parent or guardian because you're no longer a dependent).

Note: If you lost coverage or had another life change more than 60 days ago, you may qualify for a Special Enrollment Period if you previously qualified for a Special Enrollment Period, but you missed the 60-day deadline to enroll because you were impacted by the COVID-19 national emergency. Voluntarily dropping coverage doesn't qualify you for a Special Enrollment Period unless you also had a decrease in household income or a change in your previous coverage that made you eligible for savings on a Marketplace plan.

  • If your employer reduced the hours you work and you’re enrolled in a Marketplace plan: Update your application immediately within 30 days to report any household income changes. You may qualify for more savings than you’re getting now. Learn how to report changes and estimate your income.
  • If you were furloughed: In some situations, depending on the status of your health coverage from your employer, you may qualify for a Special Enrollment Period. You may be eligible for a premium tax credit to help pay for Marketplace coverage too. Create an account or log in to start your Marketplace application to find out if you qualify.
  • Need help estimating your income? Use this income calculator to make your best estimate.
  • If you qualify for COBRA continuation coverage:

    • If you’re entitled to COBRA continuation coverage after you lost your job-based coverage, you may still qualify for a Special Enrollment Period due to loss of coverage. You have 60 days after your loss of job-based coverage to enroll in Marketplace coverage. You may also qualify for premium tax credits if you end your COBRA continuation coverage, or if you didn’t accept it to begin with.
    • If you're enrolled in COBRA continuation coverage, you may qualify for a Special Enrollment Period if your COBRA continuation coverage costs change because your former employer stops contributing so you have to pay full cost, or if you get premium assistance to pay for your COBRA premiums and your premium assistance ends. Learn more about COBRA continuation coverage and the Marketplace.
    • If you qualified for COBRA because you or a household member had a reduction in work hours or involuntarily lost a job, you may have qualified for help paying for COBRA premiums. If you qualified, you would have gotten a written notice from your former employer or insurance company and had access to COBRA without having to pay premiums.

    This help ended on September 30, and so you can enroll in a Marketplace plan with a Special Enrollment Period. To enroll, you can report a September 30 "loss of coverage" on your application. You can’t qualify for a premium tax credit while you’re enrolled in COBRA, so if you want to change to Marketplace coverage, make sure that your COBRA coverage ends on the last day before your Marketplace coverage starts. Learn more about COBRA premium assistance.

  • If you lost your job, but didn’t also lose health coverage, because your former job didn’t offer coverage: You generally won't qualify for a Special Enrollment Period. By itself, a job loss (or a change in income) doesn't make you eligible for a Special Enrollment Period to enroll in Marketplace coverage.

  • If you got or are eligible to get unemployment compensation in 2021: You may be able to enroll now, even if you didn’t experience another life event. (The Marketplace will follow up with you shortly after you submit your application if you’re eligible for this Special Enrollment Period.)

Coverage start dates with a Special Enrollment Period due to loss in coverage

  • If you’ve already lost coverage, your Marketplace coverage can start the first of the month after you apply and enroll.
  • If you know you’ll lose coverage within the next 60 days, you can submit an application on HealthCare.gov before you actually lose your coverage to help make sure there’s no gap in coverage. For example, if you know you’ll lose coverage on August 30, and apply and enroll in a Marketplace plan August 10, your new coverage will start September 1.

If you can’t pay your premiums because of a hardship due to COVID-19

  • Check with your insurance company about extending your premium payment deadline or ask if they will delay terminating your coverage if you can’t pay your premiums.
  • If your household income has changed, update your application immediately. You could qualify for more savings than you're getting now.
  • If you’re getting financial assistance for Marketplace premiums, you have a three-month grace period to catch up on premium payments to avoid having your coverage terminated for non-payment. Most of the time, if you aren’t getting financial help with your premiums, you have a grace period determined by state law (often one month).

If your insurance company lowered your premium temporarily in 2020

Due to the COVID-19 emergency, some insurance companies (with prior approval from the Marketplace and their state) may have lowered health plan premiums for a month or more in 2020 (called a “temporary premium reduction”). They were allowed do this as long as it was a fixed percentage off the total premium (like 15%) and was given to all members, regardless of plan type or eligibility for advance payment of the premium tax credit (APTC).

  • If you were newly enrolled in a Marketplace plan with a premium tax credit, any temporary premium reductions that plans may have offered wouldn’t be displayed on HealthCare.gov.
  • If you were already enrolled in a Marketplace plan with a premium tax credit and your insurance company gave you a temporary premium reduction for certain months, the Marketplace may have also lowered your monthly APTC amount so that it didn’t exceed the portion of your monthly premium that counted toward coverage for essential health benefits. You’ll see any adjustments to APTC in Form 1095-A, which you’ll use to reconcile your 2020 taxes that you file in 2021. (You should have received Form 1095-A in the mail. If you haven’t, get help finding Form 1095-A.)

If you're enrolled in a Marketplace plan and your income has changed

If you’re enrolled in a Marketplace plan and your household income has changed, update your application immediately. If your income goes down or you gain a household member:

  • You could qualify for more savings than you’re getting now. This could lower what you pay in monthly premiums.
  • You could qualify for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP).
  • Need help estimating your new income? Use our income calculator to make your best estimate.

If your child is no longer living with you after their college sent them home early or due to a change in their college residence

If you plan to claim your child as a tax dependent on your federal tax return, and you currently have Marketplace savings with your coverage, you can keep your child on your Marketplace application. Read the plan's coverage documents and review the provider network carefully so you know how the plan covers care delivered in the state your child goes to school.

  • When your child moves to or from the place they live and go to school, they may be eligible for a Special Enrollment Period allowing them to enroll outside the yearly Open Enrollment Period if they:
    • Are still enrolled in a student health plan, but the coverage and benefits don’t extend to your area, or if your child’s move home means that they moved to a new ZIP code or county.
    • Had qualifying health coverage or lived in a foreign country or a U.S. territory for at least one of the 60 days before the date of their move. Note: This requirement doesn’t apply to members of a federally recognized tribe or Shareholders of Alaska Native Corporations.
  • If your child is under 26 and you’re already enrolled in Marketplace coverage, you may be able to add your child to your plan.
    • If you have Marketplace coverage with savings and don’t plan to claim your child as a tax dependent on your federal tax return, your child should set up their own Marketplace account and submit a separate application.
    • If you plan to claim your child as a tax dependent on your federal tax return, and you currently have Marketplace savings with your coverage, you can update your Marketplace application and add your child.
    • If you have Marketplace coverage without requesting savings, you can put everyone on one application.

Note: If you change plans or add a new household member, any out-of-pocket costs you already paid on your current 2021 Marketplace plan probably won’t count towards your new deductible, even if you stay with the same insurance company. Call your insurance company before changing plans or adding a new household member to find out if you’ll need to start over to meet your new plan’s deductible.

If you get a direct deposit or check from the IRS that is called an economic impact payment or for a child tax credit

The American Rescue Plan Act called for the IRS to make a third round of economic impact payments of up to $1,400 per taxpayer and $1,400 for each qualifying child. The American Rescue Plan Act also set up a new system for the child tax credit to be sent to tax filers in advance through checks or direct deposits.

If you get one of these payments, you don't need to include it in the income you report on your HealthCare.gov application. These payments don't impact your eligibility for financial assistance for health care coverage through the Marketplace, or your eligibility for Medicaid or the Children’s Health Insurance Program (CHIP). For more information, visit IRS Coronavirus Tax Relief information.

If you have limited Medicaid that covers COVID-19 diagnostic testing only

In some states, Medicaid may cover COVID-19 testing if you don’t have other health coverage and don’t qualify for full Medicaid or CHIP coverage. This limited Medicaid benefit only covers COVID testing and doesn’t cover any other health care benefits and services. It doesn’t count as having qualifying health coverage.

  • With limited coverage, you can fill out a Marketplace application to find out if you qualify for comprehensive coverage, including COVID-19 testing, through either Medicaid, CHIP, or the Marketplace with savings based on your income. When you apply, don’t tell us that you have Medicaid.
  • If you enroll in Marketplace coverage and qualify for help paying for that coverage, notify your State Medicaid agency of this new coverage.
  • Note: Like other Medicaid coverage that provides limited benefits, if your COVID-19 testing Medicaid coverage ends, you may not be able to enroll in Marketplace coverage until Open Enrollment for 2022 coverage starting November 1, 2021, unless you have a qualifying event. Learn more about Special Enrollment Periods.

Learn more about Medicaid coverage and the Marketplace.

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.
  • USA.gov/coronavirus to see what the U.S. Government is doing in response to COVID-19.