Marketplace Coverage & Coronavirus | HealthCare.gov

Market Coverage and Coronavirus: Important Updates

If you already have coverage through the marketplace, the rules for emergency treatment of coronavirus disease 2019 (COVID-19) remain the same as for any other viral infection. However, it’s important to note that your health insurance company may have additional benefits.

What Marketplace Plans Cover

All plans in the marketplace cover treatment for pre-existing medical conditions and cannot cancel coverage due to a change in health status, including COVID-19 diagnosis or treatment. It’s recommended to check with your health insurance company for specific benefits and coverage policies.

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Updating Your Marketplace Application

In case COVID-19 affects your income or household, it’s crucial to log in and update your marketplace application. Depending on your circumstances, you may be able to change your plan.

COVID-19 Vaccines: What You Need to Know

All marketplace plans cover the initial COVID-19 primary vaccines. The vaccines are categorized as follows:

Pfizer-Biontech

• Children of 6 months to 4 years: 3 shots
• Anyone over 5 years old: 2 injections
• Note: If your first injection is Pfizer-Biontech, all subsequent primary vaccines should also be Pfizer-Biontech.

Modern

• Anyone 6 months or older: 2 injections
• Note: If your first shot is Modern, your second shot must also be Modern.

Johnson & Johnson/Janssen

• Adults over 18 years of age: 1 injection

Novavax

• Anyone over 12 years old: 2 injections
• An additional primary vaccine recommended at least 4 weeks after completing the initial series of primary vaccines against COVID-19 if you have immunosuppression.

COVID-19 Diagnostic Tests and Coverage

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All health plans in the marketplace cover COVID-19 diagnostic tests performed at the office of a doctor or other healthcare provider. It’s important to note that your marketplace plan also covers COVID-19 home tests that you buy online or at a pharmacy or store.

Seeking Medical Attention: Important Steps to Follow

If you need medical attention, it’s crucial to call before going to the doctor. This step is taken to reduce the risk of exposure and protect others. Some precautions include waiting in your car until the start of the visit, using limited input, performing a COVID-19 detection test, avoiding waiting rooms and areas, maintaining social distancing, wearing a face covering, and practicing proper hand hygiene.

Job Loss or Reduction in Hours: What to Do

If you have experienced job loss or a reduction in hours, you may qualify for a special enrollment period. This period allows you to make changes to your marketplace coverage if you have lost health coverage through your employer or are expected to lose coverage within the next 60 days. It’s important to update your application immediately if your employer has reduced the hours you work.

Difficulty Paying Premiums: What You Should Know

If you are unable to pay your premiums due to a hardship caused by COVID-19, it’s recommended to check with your insurance company about extending your premium payment deadline or delaying the termination of your coverage. Additionally, updating your application right away is essential as you may qualify for more savings than you are currently receiving.

Change in Income: Update Your Application

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If you’re enrolled in a marketplace plan and your household income has changed, it’s crucial to update your application. By doing so, you may qualify for more savings and even free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP).

Child-No Longer Living with You: What to Do

If your child no longer lives with you due to a change in their college residence or early college return, there are certain steps you need to take. If you plan to claim your child as a tax dependent on your federal tax return and currently have marketplace savings with your coverage, you can keep your child on your marketplace application.

Limited Medicaid Coverage and COVID-19 Testing

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 Children’s Health Insurance Program (CHIP) coverage. However, it’s recommended to complete a marketplace application to find out if you qualify for full coverage, including COVID-19 testing, through Medicaid, CHIP, or the marketplace with savings based on your income.

Stay Informed: Latest Information on COVID-19

For the most up-to-date information on COVID-19, you can visit cdc.gov/coronavirus and usa.gov/coronavirus. These websites provide the latest public health and safety information from the CDC and the US government’s response to the pandemic.

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