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Changes in billing insurance for COVID testing

The federal government has announced an expiration to the COVID-19 emergency declaration, effective May 11.

While some things will remain unchanged, the most widespread impact will be who pays for testing and treatment. That is, insurance is dropping or changing coverage, which means ease of access and affordability will change.

Furthermore, in many cases where insurance will still cover COVID testing, they will require that it be ordered by a doctor, meaning coverage is not guaranteed (and likely won’t be) for self-initiated testing. And there still may be cost sharing associated with the doctor’s visit in the form of copays or deductibles.

This means that folks who test proactively — before/after travel, large gatherings, or contact with vulnerable people — will end up paying out-of-pocket for their COVID test should they choose to go the PCR route. At-home tests are always still an option, but the federal supply is expected to run out, and the accuracy simply does not measure up to a test processed through a lab. The at-home option comes with a lower price tag, but the tradeoff is reliable test results.

Implications for organizations

Beyond individuals who opt in to testing on their own, businesses and other organizations will also have to adapt to the policy change. Up until this point, some employers have tested their employees and billed insurance or have been reimbursed. Come May, someone will have to pick up that bill if an organization wishes to continue testing.

In some cases, like long-term care facilities, the staff represents a small percentage of total headcount compared to the residents themselves — but the staff is also most likely to be the source of a COVID outbreak. Staff health can go a long way to protect a large population of vulnerable seniors.

Advantages of organizational testing

There is some upside to running a testing program as an employer, however. Rather than the cumulative cost of all individual testers, you have the option of pooled testing. With pooled testing, all submitted samples are tested in aggregate. If the group comes back with a negative result, that’s all there is to it — you have the reassurance of no positive COVID cases across the board. If the group does produce a positive result, then the samples would be re-tested individually to determine the source. The bottom line: pool testing is more affordable than individual testing and provides full assurance that your staff and residents are safe.

You can pass this peace of mind onto your customers — the residents and their families. Happy customers create a positive feedback loop to your staff, in time savings and focus on the best parts of the work: patient care.


  • U.S. Department of Health & Human Services Press Office. “Fact Sheet: COVID-19 Public Health Emergency Transition Roadmap”. February 9, 2023. View Fact Sheet >
  • Centers for Medicare & Medicaid Services. “CMS Waivers, Flexibilities, and the Transition Forward from the COVID-19 Public Health Emergency”. February 27, 2023. View on >
  • Centers for Medicare & Medicaid Services. “Laboratories: CMS Flexibilities to Fight COVID-19”. February 24, 2023. View CMS Laboratories PDF >
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