Marketplace coverage & Coronavirus

• 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.
• Log in to update your Marketplace application if COVID-19 impacts your income or household. You may be able to change your plan if you qualify for a Special Enrollment Period due to a life change based on income.

COVID-19 vaccines

• 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.

If you paid to get a COVID-19 vaccine

• 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

• COVID-19 diagnostic tests done at a doctor's office or other health care provider, 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.
• At-home COVID-19 tests you buy online or at a pharmacy or store. Each month, you can buy up to 8 over-the-counter tests that have FDA authorization, clearance, or approval for each person on your Marketplace plan, until the Public Health Emergency ends. For example, if you have 4 household members on the same plan, you can get 32 tests each month. Your Marketplace plan will either:
  • Pay up front when you buy the test through an in-network provider
  • Reimburse you for the cost after you submit a claim. If you buy the test through a provider outside of your plan's network, your plan will reimburse you up to $12 (or the cost of the test, if less than $12).
• 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.

If you need medical care

• 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 have a change in income, household size, or lost your health coverage

• If your income changed, let the Marketplace know right away. You may qualify for more savings than you're getting now, and new plans may be available that work better for your household. You could also qualify for free or low-cost coverage through Medicaid or the Children's Health Insurance Program (CHIP).
• If you lost coverage from your job, Marketplace coverage can start the first of the month after you apply and enroll. If you're going to lose coverage in the next 60 days, you can apply for Marketplace insurance now to make sure you don't have a gap in coverage.
• 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, they may be eligible for a Special Enrollment Period. This Special Enrollment Period will end on June 9, 2023. Discover all health coverage options for young adults.

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

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.