Illinois’ Blue Cross will stop covering at-home COVID-19 tests when public health emergency ends next month

Many Illinois residents will soon have to pay for over-the-counter COVID-19 tests, with the state’s largest insurer saying it will no longer cover them once the federal emergencies for COVID-19 end next month.

Blue Cross and Blue Shield of Illinois will generally no longer cover the tests after May 11, which is when pandemic-related national and public health emergencies are set to end. Blue Cross will also change how it handles PCR tests, covering them the same way it covers other types of tests, such as flu or strep tests, depending on a person’s plan, spokesman Dave Van de Walle said in an email. Coverage of COVID-19 medication Paxlovid will also depend on an individual’s plan, he said.

Until now, the federal government has required health insurance companies to pay for up to eight over-the-counter COVID-19 tests per person per month, as well as PCR tests, at no cost to consumers, as part of an effort to control the spread of COVID-19. The government has also made Paxlovid free to patients. But once the federal emergency periods end, it will be up to insurers how to cover those tests and the treatment.

The federal government is encouraging health insurance companies to continue covering at-home COVID-19 tests after May 11 — though that encouragement doesn’t seem to be going far. Other Illinois health insurance companies are remaining mum on the issue. UnitedHealthcare, Cigna and Aetna did not answer the Tribune’s questions about how their coverage will change next month.

Medicare Part B will no longer cover over-the-counter tests after May 11, though it will still fully cover PCR tests ordered by a provider. People on Medicaid will continue getting tests for free until the end of September 2024, under federal rules.

Though Blue Cross will not be covering at-home, COVID-19 tests, it’s possible that some large employers that fund their own health insurance plans and use Blue Cross as an administrator may opt to add coverage of the tests to their employees’ plans.

Experts worry that once the tests are no longer free to everyone, people may use them even less than they do now, potentially spreading COVID-19.

The tests often cost around $10 each, depending on the brand. If a person tests positive, then that person can be done testing. But if a sick person tests negative, then that person is supposed to take a second test a day or two later, because it can take time for the virus to build up to a detectable level in the body. One negative COVID-19 test does not mean a person doesn’t have COVID-19 and can go about life freely. At-home tests are less sensitive than PCR tests.

That means that starting in mid-May, someone with the sniffles may have to shell out $20 to try to figure out if they have COVID-19 or a cold. Some people may just skip the tests and assume it’s a cold.

The changes come as a new COVID-19 omicron variant, XBB.1.16, also known as Arcturus, is spreading across the country. The variant now makes up about 10% of cases in the region of the U.S. that includes Illinois, though it does not seem more dangerous than previous variants, according to the World Health Organization.

“We’re going to see people give up testing,” said Lindsay Allen, a health economist and assistant professor of emergency medicine at Northwestern University’s Feinberg School of Medicine. “Behavior comes down to incentives. We know when we provide people with preventative care at a free or low cost they’re much more likely to use it, and that includes COVID tests. ... As soon as it becomes cost prohibitive, they’re not likely to use it.”

Dr. Emily Landon, one of the most respected medical voices on COVID-19 in Illinois, said she doesn’t expect the changes in coverage to lead to a surge in cases. However, she said, “I definitely think it’s going to make things more difficult than they are right now in terms of getting COVID care.”

For example, now many people can get the medication Paxlovid for free with a positive PCR or at-home test, and, in some cases without even needing a positive test result. It’s not yet clear how all insurance companies will handle that after May 11, though Blue Cross will follow providers’ decisions regarding whether a person needs Paxlovid, rather than always requiring a positive test for coverage, Van de Walle said.

If people give up testing, that could also create a dangerous situation for high-risk individuals, said Landon, who is chief health care epidemiologist at University of Chicago Medicine.

“If you have COVID, and you don’t know about it, you could unknowingly go about your life and put others at significant risk,” Landon said.

Most people who get COVID-19 don’t get seriously ill. But some develop long-COVID — or worse.

“About 300 Americans are going to die of COVID next week,” Landon said. “What you need to do is make every effort to not be one of those people, and you need to make sure you’re not creating those 300 deaths.”

The tricky thing is that not all high-risk people look the part. Landon is high risk because she has rheumatoid arthritis, and her medication for it suppresses her immune system. But one would never know that by looking at her, she said.

“It’s really hard because people aren’t going to wear a sign around their neck saying, ‘Please don’t give me COVID, I might die,’” she said.

Even though the tests will no longer be free, people should continue to test themselves at home if they feel ill or head to a pharmacy, clinic or testing site for a PCR test, she said. If people can’t or won’t test, they should act as if they have COVID-19, ideally staying home, and, at the very least, wearing masks in public, Landon said.

There are also a few things people can do now, ahead of May 11.

For one, people should price-shop the tests, Allen said. They should find out which stores have the lowest prices or which stores sell the tests in single-packs, which are less expensive, so they can quickly find affordable tests when they get sick in the future.

And people should order their last set of eight free tests now.

“The first thing I’d recommend is for people to stock up while they can,” Allen said.

COVID-19 vaccines will generally be fully covered, at no cost to patients, by health insurance plans, Medicare and Medicaid, even after May 11.

President Joe Biden’s administration also announced last week that it plans to ensure that people without health insurance can continue to receive COVID-19 vaccines and Paxlovid for free through a $1.1 billion partnership with pharmacy chains, health departments and certain health centers.