How to Get COVID Care Covered This Fall

The Food and Drug Administration (FDA) is expected to approve updated COVID-19 booster doses to help protect people from new variants like XBB 1.5. Then, the Centers for Disease Control and Prevention (CDC) will recommend who should get the updated COVID shots and how often they’ll be needed.

The variants aren’t the only COVID-related thing that’s changing—prevention, treatment, and tests for COVID are no longer free.

Adriane Casalotti, MPH, Chief of Government and Public Affairs at the National Association of County and City Health Officials, told Verywell that the end of the public health emergency in May of 2023 marked “a shift in the availability and cost of vaccines, tests, and treatments, particularly for the un- and underinsured.”

According to Casalotti, people who have private insurance will probably still have coverage for vaccines and treatment, but “testing costs are no longer required to be covered by private insurance.” People who are un- or underinsured “could face additional access barriers” to getting COVID-related care.

Here’s what to expect this fall in terms of paying for COVID prevention, testing, and treatment.

Coverage for COVID Vaccines If You Have Private Health Insurance 

Even though the federal government stopped purchasing additional doses of the existing COVID vaccines in early August, Cynthia Cox, MPH, a vice president with health group KFF in Washington, DC, told Verywell that “many pharmacies probably still have the federally purchased doses in stock and would be continuing to administer them at no cost regardless of a person’s insurance status.”

Since the retail price of a COVID vaccine can be $130 or more per dose, Cox said that “if you’re going to get a shot now, it’s probably still a good idea to call ahead and confirm with your doctor or pharmacy that the dose they are administering is indeed free.”

If you find out they’re not, call other pharmacies to see if they still have free shots in stock.

Once that supply is gone and updated boosters are recommended, Cox said that most people who are insured will still be able to get the vaccine for free because of vaccine coverage rules under the Affordable Care Act. (ACA). However, you’ll want to find out what your plan’s coverage terms are.

“One catch is that if you have private insurance, you’ll want to make sure you are going to a doctor or pharmacy in your network,” said Cox. “If you go out of network, your health insurance company is not required to cover the cost of the vaccine or the cost of administering it.”

To be sure your vaccine provider is in your insurer’s network, call your provider’s office or pharmacy to find out. You can also call the member number on the back of your insurance card and ask for a list of providers that are in-network.

Medicare will be covering COVID vaccines for free as well as treatment (however, beneficiaries may have to pay a copay for some treatments).

Getting Vaccinated If You’re Uninsured or Underinsured 

Being underinsured means that high deductibles and/or copays make it hard to afford health care expenses even though you technically have insurance.

“Uninsured and underinsured people may be able to get the updated booster this fall a few different ways,” said Cox. One way is to look for a local free or community-based clinic, which you can search for by state.

In the next few weeks, the CDC will be launching the Bridge Access Program to connect people who are under- or uninsured with vaccines and COVID treatment if they test positive.

Free vaccines will be available through the program for people who are eligible because of their insurance status, or clinics, providers, and pharmacy chains (including CVS and Walgreens).

Erin Loverher, a spokesperson for Walgreens, told Verywell that “contracts and discussions with HHS are underway,”

Amy Thibault, a spokesperson for CVS, told Verywell that the chain is also “talking with the CDC.” 

A spokesperson for the Department of Health and Human Services told Verywell that once the program launches, the Bridge Access Program website will have information on where you can access care.

Arielle Kane, the head of Medicaid Initiatives for health advocacy group FamiliesUSA, told Verywell that using “existing programs and the retail fronts where people already get flu shots and interact with the health care system on a daily basis makes perfect sense.”

Coverage for COVID Treatment 

The Bridge Access Program will also cover COVID treatments for people who are advised by their providers to start medication. While many people will fully recover from COVID within a week and won’t need treatments, that’s not the case for everyone.

William Schaffner, MD, a professor in the division of infectious diseases at Vanderbilt University, told Verywell that some people will still get seriously sick from COVID—and some will die.

The CDC recurrently recommends treatment for people who are aged 50 and older, immunocompromised, have underlying health conditions, or are unvaccinated.

“The guidance has changed throughout the pandemic and certain treatments have become less effective as the virus has mutated,” said Kane. “As a result, people may not know what they should do when they come down with a COVID infection.”

Even before the Bridge Access Program begins, people can seek free or low-cost COVID treatment through community health centers.

You can search by state to find out what is available where you live. If you have insurance but can’t get an appointment with your provider, contact your insurer to ask which urgent care centers are in-network (meaning you’ll just have a small copay for the visit). If you get a prescription, try to go to an in-network pharmacy (though you will likely still have to pay a copay).

Coverage for COVID Testing

According to Casalotti, “testing costs are no longer required to be covered by private insurance.”

Since the CDC still advises testing if you have been exposed to someone who tested positive for COVID or have symptoms of COVID, it’s worth asking your insurer if they will cover some or all of the cost of tests. 

Keep in mind that tests you have stashed at home might still be valid even if the date on the package has expired. The FDA has evaluated many tests and extended some expiration dates (you can check the FDA website to see if your tests are on the list).

Schaffner suggests keeping some tests on hand. If you want to stock up on COVID tests, two-test packs start at around $15.

Casalotti said that some local health departments still have free rapid tests to distribute and will be able to point residents to free tests in the community—for example at the local library. However, keep in mind that centers you might remember from the height of the pandemic may have closed or have more limited hours. 

There are still government-sponsored sites offering COVID testing, but it’s likely to be PCR testing (which can take a day or two to get results). You can check online for centers near you that offer them.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.