What Will Patients Have to Pay for COVID-19 Testing?

Among the many important considerations during this pandemic is, who and how much you’ll pay for Covid 19 testing and treatment? Lab tests conducted by the Centers for Disease Control and Prevention (CDC) and public health laboratories are the only ones that are free. The Centers for Medicare & Medicaid Services (CMS) and private health insurance companies have drafted policies over the past few days regards testing and treatment and what patients will pay for Covid 19 testing. 

Medicare

According to CMS, Medicare Part B covers a test if ordered by your doctor or another health care provider and if the test was conducted on or after February 4, 2020. If you are enrolled under Original Medicare, you will not pay anything for getting a clinical diagnostic test for an infection. 

“Anyone who feels like they need a test, we don’t want costs to be a barrier to getting that test,” said CMS administrator Seema Verma during a tele-town hall event for AARP members. 

Additionally, Medicare enrollees can hold a video call their doctor (telehealth) for a consult to avoid the risk of exposure to themselves and others, which is also covered by Medicare. Covered telehealth services include:

• Evaluation and management visits (common office visits)
• Mental health counseling
• Preventive health screenings

Medicaid

State Medicaid and CHIP programs have been provided the following guidance by CMS:

Testing

The COVID-19 test is covered under Medicaid’s mandatory laboratory service if ordered by or under the guidance of a physician or other licensed care provider. If the state has a Medicaid cost-sharing policy for the COVID-19 test, it can be eliminated by submitting an application. Similarly, states can stop charging copayments for specific items of services under CHIP by submitting a disaster relief application. 

Beneficiaries who are quarantined in the community

• Family members who are not sick can be authorized as caregivers/providers for the Medicaid patient and can be funded as a live-in caregiver. 
• The patient can be provided Meals on Wheels or other home-delivered meal service for one meal a day
• Private nurse services could also be provided
• Healthcare providers can provide telehealth services to quarantined patients as covered under their state plans

Private Insurance

Here’s what private health insurance companies are doing with respect to cost-sharing:

• Aetna: Will waive copayments for all COVID-19–related diagnostic testing for all members enrolled in the company’s commercial, Medicare and Medicaid plans. Self-funded plans can opt out. Telemedicine visits for any reason will have a zero copay. 
• AmeriHealth New Jersey: Will waive COVID-19 testing at a physician’s office, urgent care center or emergency room members of fully insured, employer-sponsored plans and individual and family plans offered through the Affordable Care Act (ACA). Telemedicine visit cost-sharing is also waived. 
• Anthem: Will cover COVID-19 testing with no out-of-pocket cost. No prior authorization (PA) required for diagnostic services related to the testing. Copays, coinsurance and deductibles will also be waived for in-network COVID-19 testing in physician’s office, urgent care or ER.
• Blue Cross Blue Shield Association (BCBSA): BCBSA’s network of local companies will waive PA for diagnostic tests and covered services for COVID-19, member cost sharing for these tests will be waived, prescription refill limits on maintenance medications will be waived and access to telehealth and nurse/provider hotlines will be expanded.
• Centene: Will cover COVID-19 testing and screening services for Medicaid, Medicare and marketplace members without cost-sharing. Prior authorization, prior certification, prior notification and step therapy will be waived.
• Cigna: Through May 31, 2020, Cigna will waive out-of-pocket costs for COVID-19 testing-related visits for in-network providers (doctor’s office, urgent care clinic, emergency room or telehealth).  
• Humana: Will waive out-of-pocket costs associated with COVID-19 testing for MA, Medicaid and commercial employer-sponsored plans. Telemedicine costs will be waived. 

Information on how to pay for Covid 19 testing in other insurance plans can be found here. 

For the Uninsured

The House has passed the Families First Coronavirus Response Act, which became a law on March 18th. Provisions in the Act will allow states to expand Medicaid coverage to uninsured individuals for COVID-19 diagnosis and testing. So, the uninsured could access free testing without any cost sharing. Treatment costs are not covered under this bill.

What Can You Do If You Suspect Being Infected?

• Contact your insurance company to confirm testing coverage 
• Call your doctor’s office about testing instead of calling into an ER

Find out if your state health department is offering the test, which will be free of cost

From The Editor:

This information is up-to-date as of 3/31/20

And because it can’t be repeated enough, read – “Covid 19 – Reducing the Risk of Infection” and join our Facebook Group, “Covid 19 Updates for Immunocompromised Communities“.

Patients Rising University acknowledges the important contributions of Surabhi Dangi-Garimella Ph.D. in this article. Improving patient access is our mission and we’re happy to utilize a variety of experts to carry that out.

UPDATED RESOURCE:

7/31/20: “Federal Push for Faster, Cheaper Coronavirus Tests Focuses on 7 New Technologies” by NPR News.