Health Plans Must Cover the Full Cost of COVID-19 Testing

As reported in other What You Need to Know Now updates on LR’s website, the recently enacted Family First Coronavirus Response Act (Act) expands emergency paid sick leave and family and medical leave during the COVID-19 emergency. However, the new law also addresses testing for COVID-19.

The Act requires all group health plans to cover the full cost of COVID-19 testing free of charge and without any employee cost-sharing, including deductibles, copayments or coinsurance. In addition, the health plan cannot require prior authorization or impose other medical management requirements. This includes both the cost of a testing kit approved by the FDA and the administration of the test. The Act applies to group health plans (including insured, self-insured and “grandfathered” plans under Obamacare) and health insurers in both the group and individual markets. (It does not apply to limited scope dental or vision plans or retiree-only plans).

Specifically, the Act requires cost-free coverage for:

•  Testing kits for the detection and diagnosis of COVID-19 that are FDA-approved, pending FDA approval or are authorized by a State
• The cost of administering the test
• The costs of visits to a health provider’s office(s), urgent care center or emergency room. To be covered free of charge, these visits must result in the ordering of testing, the administration of testing, or an evaluation to determine whether testing is needed. Office visits include “telemedicine” visits under a health plan.

However, the Act covers only testing and diagnostics, not treatment of COVID-19. You should check with your health plan or insurer to learn if cost-sharing, including deductibles and copayments, and pre-approval requirements apply to treatment of the virus. Some health plans have decided to waive cost-sharing for treatment and high-deductible plans may cover treatment of COVID-19 before an individual’s deductible is met. In addition, some state legislatures, includingNew Jersey’s, have proposed laws which would prohibit cost-sharing under covered plans with respect to treatment. We will continue to monitor developments at the federal and state level affecting health care coverage during this health emergency.