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.

Are COVID-19 lab tests covered after May 11, 2023?
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Yes, lab tests, including COVID-19 tests, are covered under health insurance policies.

Do I have to pay a deductible, copayment, or coinsurance (cost-sharing) for COVID-19 tests and outpatient visits to diagnose COVID-19 after May 11, 2023?
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Yes, if your health insurance policy imposes cost-sharing on lab tests and outpatient visits.

Can my insurer review my COVID-19 lab test for medical necessity after May 11, 2023?
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Yes, your insurer may review your COVID-19 lab test for medical necessity.

Can I go to an out-of-network provider to get a COVID-19 test after May 11, 2023?
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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.   
Will my health insurance cover over-the counter (OTC) COVID-19 tests after May 11, 2023?
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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.

Are COVID-19 immunizations covered for children after May 11, 2023?
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Yes, health insurance policies must cover COVID-19 immunizations for children under 19 years old.

Are COVID-19 immunizations covered for adults, after May 11, 2023, who are 19 years of age and older?
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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.)

Do I have to pay cost-sharing for a COVID-19 immunization after May 11, 2023?
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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.

Can I go to an out-of-network provider to get a COVID-19 immunization after May 11, 2023?
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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.

What if I was charged cost-sharing for a COVID-19 test or a COVID-19 immunization that I received on or before May 11, 2023?
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  • 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.
What should I do if I have out-of-state coverage, self-funded coverage, Medicare coverage, Medicaid coverage, Child Health Plus coverage, or Essential Plan coverage?
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  • 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.