Cost May Lead Many to Skip COVID Testing: Why That’s a Problem

Sept. 14, 2023 – For Becky Robertson of Dallas, COVID-19 testing is taking a toll on her wallet now that the federal government and her insurance are no longer covering the cost. She health said she pays around $30 per test to protect herself and her family. It’s gotten so pricey, in fact, that instead of testing, when she or a family member shows symptoms, they may quarantine at home rather than shelling out more money to know for sure. 
And she’s not the only one. Katie Camero, a recently laid-off journalist from Edison, NJ, said she, too, has been struggling with the rising cost of COVID testing. Her husband is a medical student who’s constantly fighting a scratchy throat and other symptoms as he runs around the hospital. Because of his exposure, they both test themselves frequently to protect those around them.
When one of her close friends has a new baby, for example, she likes to test out of an abundance of caution before visiting. Still, Camero said, “it’s getting really expensive to be considerate.” With the end of the COVID-19 public health emergency on May 11,  the federal government is no longer covering the cost of COVID PCR and antigen testing. But it’s worth noting that at-home antigen testing is still covered through Medicaid until 2024. Medicare will cover COVID testing at no cost if it’s prescribed by a doctor, which includes PCR and antigen tests done at a doctor’s office or hospital but not tests done at home.
During the public health emergency, the tests were required to be covered by insurance so that they were of no cost to insured patients. But since then, decisions about coverage have moved back to either the states, employers, or insurance companies. “Those on private insurance are finding that COVID testing now looks like flu testing in terms of cost,” said Christina Silcox , PhD, a policy fellow at the Duke-Margolis Center for Health Policy in Washington, DC. 
This comes after a surge in cases and hospitalizations. Nationally, COVID hospitalizations are up by 9% for the week ending Sept. 2 and COVID deaths are up by 10%, according to the CDC. And there’s a greater concern that we don’t yet know the true size of the surge because cost may lead some to skip testing, which means that people who don’t know they have an infection are less likely to take rigorous precautions to stop its spread.  “When you add cost to COVID exhaustion, you increase the incentive not to test at all,” Silcox said. 
While the data doesn’t yet show us whether cost is stopping people from getting tested, it’s likely a factor, which may also mean that we’re not gathering enough information about the virus. Rajeev Fernando , MD, an infectious disease expert and fellow at Harvard Medical School, is concerned that we’re no longer gathering accurate data on infections both to fully understand the level of a surge and also to see mutations in infection that can lead to new treatments and updated vaccinations.  “There’s been a significant decrease in bio-surveillance worldwide,” he said. “Countries used to report new variants to the World Health Organization, and now we’re just not seeing it.”
But Fernando notes that in the U.S., the CDC does have its National Wastewater Surveillance System  that monitors levels of SARS-CoV-2 (the virus that causes COVID-19) in wastewater, and those numbers currently track with increases we’re seeing in hospitals. Still, it’s important to take data about the recent surge in context, he said. While the CDC is reporting there is a surge, that’s compared to an all-time low level of infections. In January 2022, for example, the U.S. had close to 146,000 hospitalizations , compared to current numbers that are around 6,500. 
“It’s a high-increase percentage from a very low number of COVID cases,” Fernando said. The severity of illness is likely significantly lower because around 95% of Americans have some level of immunity, either from vaccination or from infection, he said.
Other experts worry that those who don’t test will delay treatment, which could affect care. Many COVID treatments that are known to be the most effective, including Paxlovid and metformin, need to be given within the first week of an infection. Paxlovid is an antiviral pill that has been shown to reduce the risk of hospitalizations by 89% in high-risk people, and metformin has been shown to cut the risk of getting long COVID from an acute infection by 41%. For those who don’t know they have COVID, symptoms may end up getting much worse before they seek treatment.  “It’s foolish for insurance companies not to cover the cost of testing, because they may end up paying for many more days in the ICU,” said Grace McComsey, MD, who leads the long COVID RECOVER study at University Hospitals Health System in Cleveland.
For those who don’t test or seek treatment, a mild infection can still lead to long COVID, which McComsey said is a far greater threat to many patients than an acute infection. According to the CDC, 7.5% of Americans already have long COVID symptoms, including intense fatigue, chronic pain, shortness of breath, and chest pain lasting 3 or more months after first getting an infection. 
Both at home and around the globe, and even with the added cost, it’s still important to test, said Silcox. Those who can’t afford at-home tests may still find free testing at a community health center, public health department, libraries, or other local organizations. You can also buy tests ahead of time, before you’re sick; using drugstore coupons; or you can buy them online or in bulk for a cheaper price. The CDC also has a No-Cost COVID Test Locator on its website.  “If you have them in the house before you get sick, then you’re not at the mercy of retail pricing,” Silcox said. 
And if you’re not testing, be sure to quarantine when you’re feeling symptoms and remember that at-home tests are not perfect. “You can be infected for a day or two before they pop positive,” said Silcox. So if you’re going around older or immunocompromised individuals, don’t underestimate the power of a high-quality mask – they’re cheaper and they save lives.