COVID-19 Update: Aetna Coverage Changes

California Colorado Texas

On January 30, 2023, it was announced that the two national emergencies addressing COVID-19 – the public health emergency (PHE) and the national emergency – will conclude on May 11, 2023. As a result, health plans and group plan sponsors will no longer be subject to federal requirements for coverage of COVID-19 testing, vaccinations, and treatments starting May 12, 2023.

For fully insured plan sponsors, here is a summary of the coverage changes that will take place once the federal emergencies end:

COVID-19 Benefits During the emergency period Starting May 12, 2023
COVID-19 vaccines, including boosters Members pay $0 for the vaccine at any location. Members pay $0 for the vaccine at in-network locations. *
COVID-19 at-home test kits (OTC test kits) Members pay $0 for select test kits. Members will pay the retail cost of test kits.
Lab tests (rapid diagnostic and swab-and-send tests) Members pay $0 at in-network locations. Members will pay copay, coinsurance or deductible.
E&M - Telemedicine, Urgent Care, ER, Office Visits Members pay $0 for COVID-19 associated visits (INN and OON) Members will pay copay, coinsurance or deductible.
COVID-19 anti-viral medications (like Paxlovid) Members pay $0 for these prescriptions. No change. Members pay $0 while government supply is available.
Pharmacist Assessment and Prescribing of Paxlovid program Members pay $0 at pharmacies, including CVS. No change.
COVID-19 monoclonal antibody treatments Members pay normal cost sharing for EUA-approved treatments. No change. Members continue to pay normal cost sharing.
COBRA, HIPAA, special enrollment, claims, appeals National emergency extended deadlines for various processes. Deadlines return to normal timeframes starting July 10, 2023.

*Under an EUA declaration, the FDA may authorize unapproved medical products or unapproved uses of approved medical products to be used in an emergency to diagnose, treat, or prevent serious or life- threatening diseases or conditions.


Please note that state-specific COVID-19 coverage requirements may have different expiration dates. Aetna will adhere to all federal and state mandates as necessary. For example, California Fully Insured commercial plans will continue to cover COVID-19 testing, vaccines, therapeutics, and OTC test kits without prior authorization and with no member cost sharing for in-network providers until November 11, 2023. After that date, out-of-network services will be subject to cost-sharing.