The federal public health emergency for COVID-19 ended on May 11, 2023, and you may wonder what it means for you. For CalPERS health members, the good news is access to COVID-19 testing, treatment, and vaccines remains largely unchanged.
We’ve extended coverage in those health plans affected by the federal changes, and we’ve worked closely with our plans to ensure you don’t experience any disruption getting COVID-19 services when you need them.
Basic Plan Members Have No Changes Until November 11, 2023
For CalPERS Basic plan members, California law adds six months to the end of the public health emergency, so those in California will continue to have free coverage for COVID-19 diagnostic tests, vaccines, and treatment whether in- or out-of-network, with no prior authorization until November 11, 2023.
After November 11, 2023, access to COVID-19-related services will continue but you may pay a copay, deductible, or coinsurance, depending on your plan and the services you need.
For Kaiser members outside California, providers are subject to federal rules. After May 11, 2023, they will no longer be required to cover the cost of COVID-19 tests, treatment, or vaccines obtained out-of-network.
Medicare Plan Members May Incur Some Cost Share
For Medicare plan members, cost share may apply for some COVID-19 related services after May 11, 2023. Cost share is the share of health insurance costs that you pay out of your own pocket. It includes copays, coinsurance, and deductibles, but not premiums or costs for non-covered services.
Here’s a Guide to Help You Navigate Access and Costs
Clinical Diagnostic COVID-19 Tests Conducted by Licensed Providers
Basic HMO and PPO plans after November 11, 2023
- No member cost share for in-network services or services received from in-network preferred providers.
- Cost share will apply for services received out-of-network.
Medicare Advantage plans after May 11, 2023
- No cost for the test itself, but cost-sharing may apply for the doctor’s visit.
Medicare Supplement plans after May 11, 2023
- No cost for the test or doctor’s visit.
At-Home COVID-19 Tests
Basic HMO and PPO plans after November 11, 2023
- No member cost share for tests obtained from in-network providers.
- Health plans to pay or reimburse for eight at-home tests per month. Ask your health plan for details.
- Cost share will apply for tests obtained out-of-network.
Medicare Advantage and Supplement plans after May 11, 2023
- No member cost share for tests obtained from in-network providers.
- Health plans to pay or reimburse for eight at-home tests per month. Ask your health plan for details.
- Cost share will apply for tests obtained out-of-network.
Outpatient COVID-19 Treatment in California (e.g., Paxlovid)
Basic HMO and PPO plans after November 11, 2023
- No member cost share for in-network services or services received from in-network preferred providers.
- Cost share will apply for services received out-of-network.
Medicare Advantage plans after May 11, 2023
- No cost for the test itself, but cost share may apply for the doctor’s visit.
Medicare Supplement plans after May 11, 2023
- No cost for the test or doctor’s visit.
COVID-19 Vaccines and Boosters
All CalPERS members will continue to have access to COVID-19 vaccines and boosters at no cost under preventive benefits.
For more information and other resources, visit the CalPERS website.
Note: All CalPERS members should consult with their health plans and providers to understand how the end of the federal public health emergency affects their particular benefit options.