As the number of people infected with COVID-19 rapidly rises, insurers and government programs in the United States are taking steps to lower the costs of getting tested for the virus.
More than three dozen insurers said they would waive copays and other costs for testing, and the federal government announced testing would be covered as a mandatory essential health benefit for individual and small-group marketplace plans.
Some governors across the country have imposed no-copay requirements on health insurers. Gov. Andrew M. Cuomo on March 2 required health insurers licensed by the state to waive cost sharing for testing, as well as associated emergency room, urgent care and office visits. He also announced that New Yorkers receiving Medicaid coverage would not have copays for such testing.
But not everyone can assume the cost-cutting measures will apply to them. Coverage is optional for self-insured plans and large-group market plans and can vary according to individual plans. Among insurers offering lower or no out-of-pocket costs for testing and care are Anthem, Aetna, Cigna, EmblemHealth, Blue Cross Blue Shield Association members, Oscar and United Healthcare, according to AHIP, a trade association of American health plans.
As for Medicaid and CHIP, a Centers for Medicare and Medicaid fact sheet noted: “Though these are commonly covered services, testing and diagnostic services are an optional benefit category, and can vary by state.” It added that “children are eligible to receive all necessary testing, and that laboratory and X-rays are covered by Medicaid in all states.” Medicare patients are covered under Medicare Part B, but Medicare Advantage patients’ coverage for COVID-19 testing depends on their insurer.
Coverage for the uninsured, the underinsured, and those with high deductibles are far less clear. While the health insurer Cigna, among others, also has waived deductibles as well as copays for those getting tested, other insurers may not. Testing performed through the state Health Department is free, although patients may have to pay for office, clinic or emergency room visits.
Centers for Disease Control and Prevention director Robert Redfield says his agency is working to make sure uninsured Americans can get tested for coronavirus if it’s medically needed.
About 28 million Americans are uninsured. Rep. Katie Porter (D-Calif.) pressed Redfield on their predicament Thursday at a congressional hearing. Porter says the Health and Human Services Department has the legal authority to pay for health costs.
Redfield said he agreed. "Those individuals who are in the shadows can get the health care that they need during the time of us responding to this crisis,” he said.
“There is pretty high exposure to out-of-pocket costs, and it could deter people from seeking care,” said Kathy Hempstead, a senior policy adviser focusing on cost and coverage for the Robert Wood Johnson Foundation. “Ten percent of the population is uninsured.”
She said policymakers were scrambling to deal with the problem of providing broad testing and care, and that the response reflected “how complicated and fragmented and financially onerous our health care system is."
"There is no global fix for this, there are so many segments to the health insurance market and each segment has its own financing set of rules, copays versus deductibles," Hempstead said. "Some plans are supervised by states, some by the federal government. It’s just really, really Byzantine and this episode is really putting it on display.”
In addition, most people are not likely to get COVID-19 testing unless they meet specific guidelines from the CDC. Individuals recommended for testing include those who have had contact with another person known to be positive; symptomatic individuals who have traveled to the five countries where COVID-19 is very active; and patients admitted with pneumonia when COVID-19 is a potential cause.
“NYU Winthrop is following the CDC guidelines as to who is to be tested,” said Dr. Barry Rosenthal, chairman of emergency medicine at NYU Winthrop, the facility where Nassau County’s first confirmed COVID-19 patient remains hospitalized.
In general, the work-up for a patient with a cough, a fever and a suspected viral illness is a flu test and possibly an X-ray as a check for pneumonia, Rosenthal said.
"This same work-up applies now," Rosenthal said. "More extensive viral panels that look for a multitude of different viruses, for which there are no specific treatments, and COVID-19 testing are not performed routinely on patients who are being discharged from the emergency department.”
Those extensive viral panels are performed for admitted patients with respiratory symptoms like pneumonia. If those tests are negative, a COVID-19 test can be performed.
In general, copays and charges for those tests have not been waived, although telemedicine visits may be.
Quest Diagnostics and LabCorp, two of the nation’s biggest commercial labs, have begun sending out thousands of tests to its labs for testing samples sent in by physicians, but have not released any price for the tests as yet.
New Jersey will waive copays and cost-sharing for COVID-19 testing for state health plans, state workers and public school employees, Medicaid program participants and uninsured residents eligible for charity care. The waivers cover emergency room care, urgent care and office visits related to the testing.