On Jan. 30, 2023, the Biden Administration announced it will end the public health emergency (and national emergency) declarations on May 11, 2023.

PCR and rapid tests ordered or administered by a health professional

What’s changing: Although most insured people will still have coverage of COVID tests ordered or administered by a health professional, these tests may no longer be free.

  • For people with traditional Medicare, there will be no cost for the test itself, but there could be cost-sharing for the associated doctor’s visit.
  • For people with Medicare Advantage and private insurance, the test and the associated doctor’s visit both might be subject to cost-sharing, depending on the plan. Additionally, some insurers might begin to limit the number of covered tests or require tests be done by in-network providers. People in grandfathered or non-ACA-compliant plans will have no guarantee of coverage for tests and may have to pay full-price.
  • For people with Medicaid, there will continue to be free tests through September 2024, after which point, states may limit the number of covered tests or impose nominal cost-sharing.
  • Uninsured people in the 15 states that have adopted the temporary Medicaid coverage option will no longer be able to obtain COVID-19 testing services, including at-home tests, with no cost-sharing as this program ends with the public health emergency.

What’s the same: Uninsured people in most states were not eligible for the temporary Medicaid pathway for COVID testing and therefore will continue to pay full price for tests unless they can get tested through a free clinic or community health center.

Have any questions regarding this notice? Don’t hesitate to contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.