Insurers, regulators respond to cost concerns
Insurers and policymakers took a series of steps over the past couple of weeks aimed at easing some out-of-pocket costs for patients:
• Insurance commissioners and governors of several states, including California, New York and Washington, directed health insurers to cover the full cost of screening and testing for COVID-19 for their members. California and New York ordered insurers to also waive costsharing for the associated emergency department, urgent-care and doctor’s office visits for the testing. States’ orders are limited to state-regulated health plans and do not apply to self-funded employers.
• Major health insurance trade associations, including America’s Health Insurance Plans and the Blue Cross and Blue Shield Association, pledged that their plans will cover medically necessary coronavirus testing, ease prior authorization requirements for members affected by the outbreak, and encourage the use of telehealth. Dozens of individual insurance companies, including Cigna and United-Health Group, announced they would waive copays and deductibles for the tests, while some promised free virtual-care visits or early refills for maintenance medications.
• The CMS encouraged Medicare Advantage plans to eliminate or reduce cost-sharing for COVID-19 tests and treatments delivered in doctor’s offices, EDs or via telehealth. The agency said Advantage insurers may also remove prior authorization requirements, lift limits on prescription refills, relax restrictions on home delivery of prescription drugs, and expand access to certain telehealth services. The agency confirmed that original Medicare will cover coronavirus tests and a vaccine, if one becomes available.
• The IRS issued guidance allowing high-deductible health plans with health savings accounts to cover the full cost of coronavirus testing before the plan member meets the deductible. Except for certain preventive-care services, patients with such plans usually are required to pay the full cost of medical care until they meet a deductible and coverage kicks in. The guidance allays employers’ concerns that covering tests for workers with high-deductible plans would bar them from contributing to an HSA tax-free.
• Health plans, state officials and Medicaid experts urged policymakers to declare that state Medicaid programs will cover COVID-19 testing and treatment for Medicaid-eligible people without patient cost-sharing.