While the Federal Public Health Emergency (PHE) ended on May 11, 2023, some medical plans are mandated to cover COVID-19 tests, vaccines, and therapeutics for six additional months, through Nov. 11, 2023, in accordance with the State of California’s Senate Bill (SB) 1473. Self-funded and Medicare plans are not required to comply.
At-home over-the-counter antigen tests
UC Medicare Choice, Kaiser Senior Advantage HMO and UC Medicare PPO plans do not cover antigen tests as of May 12, 2023.
Kaiser HMO will continue to cover antigen tests through Nov. 11, 2023.
UC’s non-Medicare PPO and UC Blue and Gold plans will continue to cover antigen tests through Dec. 31, 2023.
Please note that the Navitus and Anthem public websites, which serve all Navitus and Anthem members, list the end date of coverage for antigen tests as May 15, 2023. This information does not apply to members of UC non-Medicare PPO plans.
PCR tests
UC Medicare and non-Medicare PPO plans will continue to waive the cost share for PCR tests that are ordered by physicians through Dec. 31, 2023.
UC Blue & Gold HMO will continue to waive the cost-share for diagnostic PCR tests if ordered by an in-network or out-of-network physician through Dec. 31, 2023. UC Blue & Gold HMO will waive the cost-share for antibody PCR tests by out-of-network physicians through Nov. 11, 2023
After Dec. 31, 2023, UC Blue & Gold HMO will no longer cover diagnostic or antibody PCR tests by out-of-network providers or labs.
Kaiser HMO and Kaiser Senior Advantage HMO will continue to waive the cost-share for PCR tests through Nov. 11, 2023.
UC Medicare Choice will continue to waive the cost-share for PCR tests ordered by physicians until further notice.
COVID-related treatment and care
For the most part, treatment and care related to COVID-19 are now covered as regular plan benefits, with the same cost-sharing rules as would otherwise apply.
UC Blue & Gold HMO waives the usual cost-share for medical visits (to an office, urgent care facility or emergency room) for the purpose of screening for COVID testing.