COVID-19 and Health Insurance Coverage

Over the past several weeks, Americans have been following recommendations from the Centers for Disease Control (CDC) to lessen their risk of contracting Coronavirus (COVID-19).

As you wash your hands, sanitize surfaces and practice social distancing, you may be wondering if and how much your insurance will cover if you need a test or medical treatment.

Early reports claimed patients were charged thousands of dollars for testing, until the Families First Coronavirus Response Act was passed on March 18, 2020. Among its many policy changes, the Act limits how much insurance companies can charge for the test, eliminating deductibles and co-payments for patients. As of March 25, the cost of testing, the doctor’s visit or trip to the emergency room, should be free.

Some insurance carriers have updated the verbiage on their websites. The new messaging states that all costs related to visits involving a COVID-19 test, done at an approved laboratory location, will be waived for all plans over the next three months.

Additionally, Medicare and Medicaid are covering the test for individuals that use these government plans and those completely without health insurance coverage.

Confusion Surrounding Coronavirus Testing

Confusion arose after President Trump claimed all health insurance carriers would eliminate copayments for COVID-19 treatments and extend coverage to those treatments during a speech on March 11. Yet multiple sources, including the New York Times, pointed out treatment might not be free. Patients may have to pay if they:

  • Seek treatment at a hospital outside of their plan’s network.
  • Receive unrelated tests, in addition to the test for COVID-19.
  • Test positive for influenza or pneumonia and receive treatment for that condition.

The Internal Revenue Service also announced that high-deductible plans will cover testing and treatments for COVID-19, while still allowing the insured to contribute to a Health Savings Account. In this specific instance, the insurance company will cover costs related to testing and treatment, similar to how high-deductible plans treat preventative care, reducing out-of-pocket costs for insureds.  

Similarly, the Blue Cross and Blue Shield Federal Employee Program released a press release, stating the insurance carrier will waive co-pays and deductibles for any medically necessary treatments, as well as prior authorization requirements. Doing so will allow members faster access to appropriate care.

America’s Health Insurance Plans (AHIP) initially stated that patients are still responsible for paying all standard out-of-pocket costs, even for medically necessary treatments. Yet, the lobbying group has also said it plans to eliminate barriers for patients seeking treatment.

None of this addresses the issue of the underinsured or uninsured, attempting to receive treatment after testing positive. As one measure, Connecticut and a handful of other states have re-opened Affordable Care Act enrollment to allow the uninsured to obtain coverage, according to a report from NPR. Officials believe that individuals unable to seek care or who intentionally avoid treatment have a higher likelihood of spreading the virus. Opening the enrollment period will allow uninsured individuals to get coverage, active on April 1, 2020.

Unsure how your policy will cover COVID-19 testing and treatment? To discuss your policy, contact Ion Insurance today.