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As Americans adapt to living amid a lingering pandemic and employers craft policies to help their employees safely reenter workspaces — all of which require testing, often even for the vaccinated — some Americans have received an unwelcome surprise: medical bills.

That’s because, despite federal laws designed to make COVID-19 testing cost-free for patients, there is still a coverage loophole that can leave some people who get tested — whether to be safe before visiting a vulnerable relative or because their jobs require regular testing even if they are vaccinated and have no symptoms — holding the tab.

These costs aren’t cheap: Tests normally range from $20 to $100 each, but recently, due to insurer price gouging and billing errors, some Americans have been hit with bills in the thousands of dollars. According to a recent New York Times analysis, 2.3 percent of COVID tests among those sampled resulted in out-of-pocket costs to the patient. If that’s a representative figure, that means that out of the roughly 1.65 million COVID tests administered daily in the country, nearly 40,000 Americans fall through the loophole.

In cases of regular workplace testing, the government needs to draw a distinction between workers who have received a vaccine, or have a valid reason not to, and those who have simply refused vaccination. People who have chosen to do their part to fight the pandemic by getting vaccinated shouldn’t pay the price of ongoing tests to keep their homes, communities, and workplaces safe. The federal government has already made important moves protecting Americans from the high costs of needed COVID-19 testing. But the Biden administration must go further and issue regulations and clarify guidance that protects Americans from the unexpected costs, while still giving employers the leeway to pass on to workers who refuse to get vaccinated the costs of their own testing.


Under the Families First Coronavirus Response Act and the CARES Act, insurance coverage for COVID testing at no cost to the patient was expanded to include testing, for example, for patients with no known exposure to the virus and who are asymptomatic.


It was clear from the guidance issued by the Centers for Medicare and Medicaid Services that the coverage was meant to extend beyond diagnoses in a medical setting.

“For example, covered individuals wanting to ensure they are COVID-19 negative prior to visiting a family member would be able to be tested without paying cost sharing,” the guidance states.

But loopholes in the coverage provisions — those that do not cover tests given outside of clinics or other medical facilities, or that don’t deal with out-of-network testing labs that can charge higher prices that are passed on to the patient if insurers refuse to pay — have left some Americans without full coverage of the testing they need.

CMS must clarify in its guidance that free means free, ending the ability of insurers and those providing testing services to profit from the current loophole.

The Labor Department has begun drafting rules implementing the administration’s new mandate governing workplaces with more than 100 employees to require their workers be vaccinated or produce a weekly negative test result. The rules could give employers more options of how to cover the costs.

There is a clear exception here: workers who refuse to get vaccinated without a valid reason, forcing employers to ensure those workers are regularly tested in order to protect other employees. Some companies have wisely passed on the costs of that testing to employees who eschew vaccines. Delta Airlines, for example, has added $200 to the monthly health care premiums of unvaccinated employees to make up for the added expense. MGM Resorts charges employees a $15 co-pay for on-site testing, which is required, or require them to get testing themselves at their own expense.


These policies place the burdens where they belong, on employees who refuse the best means of not only keeping workspaces safe but also bringing the pandemic to its end. That cost should not be borne by employers, vaccinated workers, or taxpayers. Labor Department rules and guidance should make clear that employers are well within their rights and in compliance with federal rules to continue make unvaccinated employees bear that cost. Such a policy can also motivate more people to get vaccinated.

But when it comes to workers who fall within valid vaccination exemptions due to medical conditions, or those whose workplaces require testing on top of vaccination, the Biden administration needs to fill the coverage gap now.

Editorials represent the views of the Boston Globe Editorial Board. Follow us on Twitter at @GlobeOpinion.