Coronavirus (COVID-19) Information: Health Insurance FAQs
Consumer FAQs for COVID-19 Testing and COVID-19 Immunizations After the Public Health Emergency (PHE) Ends on May 11, 2023
The following information applies to individual and group health insurance that you or your employer purchased in New York, including through the NY State of Health Marketplace or the New York State Health Insurance Program (NYSHIP) for public employees. It does not apply if your policy was issued in another state, your employer self-funds your coverage, you are covered under Medicare, or you are covered under Medicaid, the Essential Plan, or Child Health Plus.
Yes, lab tests, including COVID-19 tests, are covered under health insurance policies.
Yes, if your health insurance policy imposes cost-sharing on lab tests and outpatient visits.
Yes, your insurer may review your COVID-19 lab test for medical necessity.
Insurers are not required to cover COVID-19 testing out-of-network unless:
- your policy includes out-of-network coverage (check your policy to see if you have out-of-network coverage);
- your insurer has approved a referral to an out-of-network provider;
- the services result in a surprise bill; or
- the services are emergency services that are provided in a hospital.
Your insurer is no longer required to cover OTC COVID-19 tests after May 11, 2023. However, some insurers may choose to continue to cover OTC COVID-19 tests. You should check with your insurer to see if OTC COVID-19 tests are still covered under your health insurance policy.
Yes, health insurance policies must cover COVID-19 immunizations for children under 19 years old.
Yes, COVID-19 immunizations are covered for adults 19 years of age and older who are covered under a non-grandfathered plan. Non-grandfathered plan means a health insurance policy purchased after March 23, 2010 or a health insurance policy purchased on or before March 23, 2010 that lost its grandfathered status. (Ask your employer whether your plan is grandfathered.)
No, you do not have to pay cost-sharing for a COVID-19 immunization that is covered under your health insurance policy if you go to an in-network provider.
Insurers are not required to cover COVID-19 immunizations when provided by an out-of-network provider, unless your policy includes out-of-network coverage. Check your policy to see if you have out-of-network coverage.
- Contact your insurer. Let your insurer know if you were charged cost-sharing for a COVID-19 test or a COVID-19 immunization you received on or before May 11, 2023 and request a refund or credit for that payment.
- Contact the Department of Financial Services. If you are unable to resolve the issue after contacting your insurer, file a complaint with DFS.
- Out-of-State Coverage. If your employer bought your policy in another state, contact your employer for information.
- Self-Funded Coverage. If your employer self-funds the coverage, contact your employer for information.
- Medicare. If you have Medicare coverage, visit the Centers for Medicare & Medicaid Services (CMS) Medicare website or call (800) MEDICARE or the Medicare Rights Center at (800) 333-4114.
- Medicaid, Essential Plan, or Child Health Plus Coverage. If you have Medicaid, Essential Plan, or Child Health Plus coverage, check with your plan or visit the Department of Health’s website at www.health.ny.gov.