Cost of COVID-19 Testing vs. Treatment

COVID-19 Testing and Treatment Cost-Share

• • The Families First Act, as amended by the CARES Act, requires private health insurance plans to cover TESTING needed to detect or diagnose COVID-19, and the administration of that testing, without cost-sharing or medical management requirements. These requirements apply to group health plans and insurers that offer individual and group health insurance coverage. This requirement is in effect during the emergency only, which is currently set to expire on October 18, 2021.

  • Federal guidance released in early 2021 under the Biden Administration clarified that insurers are not required to cover COVID-19 testing without cost-sharing if it is conducted as part of employee return-to-work programs or public health surveillance purposes.

See the following links for details on costs associated with COVID-19 TESTING.

• • • Priority Health

    • UHC

    • BCBS

    • Aetna

  • A handful of states required or created agreements with insurers to waive COVID-19 out-of-pocket TREATMENT costs, however, there is no federal mandate requiring insurers to do so.

  • Earlier in the pandemic, the vast majority of people enrolled in fully-insured private health plans would have had their out-of-pocket costs waived by insurers if they were hospitalized with COVID-19. In the last few months, the environment has shifted with safe and highly effective vaccines now widely available. A recent study showed that 72% of the two largest insurers in each state and DC (102 health plans) are no longer waiving these costs, and another 10% of plans are phasing out waivers by the end of October.

See links below for details about costs associated with COVID-19 TREATMENT

• • • Blue Cross Blue Shield of Michigan: Treatment waiver expires September 30, 2021

    • Priority Health: Treatment waiver expires September 30, 2021

    • UHC: Treatment waiver expired January 31, 2021

    • Aetna: Treatment waiver expired February 28, 2021.