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

All Marketplace plans cover:

• Your initial primary COVID-19 vaccines from one of these vaccine series:
  • 2 shots of Pfizer for anyone 5 years or older (If your first shot is Pfizer, your second shot should also be Pfizer.)
  • 2 shots of Moderna for adults 18 years or older (If your first shot is Moderna, your second shot should also be Moderna.)
  • 1 shot of Johnson & Johnson/Janssen for adults 18 years or older
• An additional primary shot (also called a "third dose") of the Pfizer or Moderna COVID-19 vaccine 28 days after your second shot if you’re immunocompromised (like people who have had an organ transplant and are at risk for infections and other diseases). Note: An additional third dose is different from a booster shot. Don’t mix vaccines if you’re eligible for a third dose because you’re immunocompromised. If your first two doses were Pfizer, your third dose should also be Pfizer. If your first two doses were Moderna, your third dose should also be Moderna. Learn more about third doses if you’re immunocompromised at CDC.gov.
• A COVID-19 vaccine booster shot.
  • Adults 18 years or older can get a booster from the same COVID-19 vaccine series you originally got, or choose a different one.
  • Teens 12-17 years old can only get a Pfizer COVID-19 booster.
  • If you got a Pfizer or Moderna COVID-19 vaccine: You should get a booster shot 5 months after you complete your second dose.
  • If you got a Johnson & Johnson/Janssen COVID-19 vaccine: You should get a booster shot 2 months after you got your first shot.
• A second COVID-19 vaccine booster shot.
  • Adults 50 years or older who got an initial booster shot of Pfizer, Moderna, or Johnsons & Johnson/Janssen COVID-19 vaccine at least 4 months ago can get a second booster shot of Pfizer or Moderna COVID-19 vaccine.
  • Adults who are moderately to severely immunocompromised (like solid organ transplants) who got an initial booster shot of Pfizer, Moderna, or Johnsons & Johnson/Janssen COVID-19 vaccine at least 4 months ago can get a second booster shot of Pfizer or Moderna COVID-19 vaccine.
  • Teens 12-17 years old who are moderately to severely immunocompromised (like solid organ transplants) who got an initial booster shot of Pfizer COVID-19 vaccine at least 4 months ago can get a second booster shot of Pfizer COVID-19 vaccine.
  • Adults who got an initial primary shot and initial booster shot of Johnsons & Johnson/Janssen COVID-19 vaccine at least 4 months ago can get a second booster shot of Pfizer or Moderna COVID-19 vaccine.

Learn more about booster shots at CDC.gov.

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 done at a doctor's office or other health care provider in your plan's network, 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.

Starting January 15, your Marketplace plan covers at-home COVID-19 tests you buy online or at a pharmacy or store.

• You can buy up to 8 over-the-counter tests a month for each person on your Marketplace plan. For example, if you have 4 household members on the same plan, you can get 32 tests each month. Note: Marketplace plans will only cover at-home over-the-counter COVID-19 tests that have FDA authorization, clearance, or approval.
• 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).

Call your health insurance plan for more details.

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 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.

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 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 2022 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 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 the Children’s Health Insurance Program (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: If your COVID-19 testing Medicaid coverage ends outside the yearly Open Enrollment Period, you won’t be eligible to enroll in a Marketplace health plan unless you had another life event that qualifies you for a Special Enrollment Period, since limited Medicaid doesn’t count as qualifying health coverage.

When filling out your Marketplace application, if your only coverage ending is COVID-19 testing Medicaid coverage, don’t tell us:

• You were recently found not eligible for Medicaid or CHIP by your state.
• You’re losing or recently lost Medicaid.
• Your current coverage is ending.

Learn more about:

• Special Enrollment Periods
• Medicaid & CHIP coverage

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.