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| Now That Coronavirus Tests Are Free, Some Insurers Are Waiving Costs for Treatment | Now That Coronavirus Tests Are Free, Some Insurers Are Waiving Costs for Treatment |
| (7 days later) | |
| This article was updated to reflect changes in government and insurers’ policies. | This article was updated to reflect changes in government and insurers’ policies. |
| Policies regarding your out-of-pocket costs for coronavirus testing and treatment are changing rapidly. | Policies regarding your out-of-pocket costs for coronavirus testing and treatment are changing rapidly. |
| State insurance regulators are taking steps to limit how much you might eventually owe, and insurance companies and employers have also changed the rules for most plans to eliminate deductibles or co-payments for testing. | State insurance regulators are taking steps to limit how much you might eventually owe, and insurance companies and employers have also changed the rules for most plans to eliminate deductibles or co-payments for testing. |
| Now insurers are starting to waive out-of-pocket costs if you need to go to the hospital, and that could reduce your bills. But it’s still unclear how much you’ll wind up paying, leaving public health experts worried that people who are sick may hesitate to get medical care because of concerns over bills. | Now insurers are starting to waive out-of-pocket costs if you need to go to the hospital, and that could reduce your bills. But it’s still unclear how much you’ll wind up paying, leaving public health experts worried that people who are sick may hesitate to get medical care because of concerns over bills. |
| “The problem is we have reams and reams of evidence that if people know they face hundreds or thousands of dollars in bills, they’ll hesitate, they’ll wait and see,” said Sabrina Corlette, a research professor at Georgetown University. | “The problem is we have reams and reams of evidence that if people know they face hundreds or thousands of dollars in bills, they’ll hesitate, they’ll wait and see,” said Sabrina Corlette, a research professor at Georgetown University. |
| But insurers and employers are taking steps to limit what you might owe. “Almost every relevant person or entity has said something about holding consumers harmless,” said Katherine Hempstead, a senior policy adviser at the Robert Wood Johnson Foundation. | But insurers and employers are taking steps to limit what you might owe. “Almost every relevant person or entity has said something about holding consumers harmless,” said Katherine Hempstead, a senior policy adviser at the Robert Wood Johnson Foundation. |
| With the caveat that things are shifting, here’s what you should know. | With the caveat that things are shifting, here’s what you should know. |
| Under the legislation just passed by Congress, testing for the coronavirus is free, as are the cost of a doctor’s visit or trip to the emergency room to get the test. | Under the legislation just passed by Congress, testing for the coronavirus is free, as are the cost of a doctor’s visit or trip to the emergency room to get the test. |
| Worried that residents might hesitate because of the potential bills, many states, including California, New York and Washington, had already required the insurance companies they regulate to cover the cost of a test, according to a recent analysis from Georgetown University. | Worried that residents might hesitate because of the potential bills, many states, including California, New York and Washington, had already required the insurance companies they regulate to cover the cost of a test, according to a recent analysis from Georgetown University. |
| Private insurance companies had also generally volunteered to waive any costs their members might face for the actual test. Employers who offer plans and are self-insured followed suit. | Private insurance companies had also generally volunteered to waive any costs their members might face for the actual test. Employers who offer plans and are self-insured followed suit. |
| Government programs like Medicare and Medicaid are also covering the test, which isn’t that expensive; Medicare is paying anywhere from $36 to $51 for the actual test. | Government programs like Medicare and Medicaid are also covering the test, which isn’t that expensive; Medicare is paying anywhere from $36 to $51 for the actual test. |
| People without insurance, or those enrolled in so-called junk plans that don’t meet the standards for insurance under the Affordable Care Act, should also be able to get tested at no cost, said Karen Pollitz, a senior fellow at the Kaiser Family Foundation, which recently released an issue brief on private insurance coverage of the coronavirus. | People without insurance, or those enrolled in so-called junk plans that don’t meet the standards for insurance under the Affordable Care Act, should also be able to get tested at no cost, said Karen Pollitz, a senior fellow at the Kaiser Family Foundation, which recently released an issue brief on private insurance coverage of the coronavirus. |
| It’s possible, especially if you go somewhere outside your health plan’s network or undergo unrelated tests. “There are still questions about the battery of testing people may receive and out-of-network testing,” said Cheryl Fish-Parcham, the director of access initiatives at Families USA, a consumer advocacy group. | It’s possible, especially if you go somewhere outside your health plan’s network or undergo unrelated tests. “There are still questions about the battery of testing people may receive and out-of-network testing,” said Cheryl Fish-Parcham, the director of access initiatives at Families USA, a consumer advocacy group. |
| You could also face sizable out-of-pocket costs if you have something that looks like the coronavirus, like the garden-variety flu, but isn’t. While New Mexico is requiring insurers to cover testing for flu and pneumonia, so far it’s an exception. | You could also face sizable out-of-pocket costs if you have something that looks like the coronavirus, like the garden-variety flu, but isn’t. While New Mexico is requiring insurers to cover testing for flu and pneumonia, so far it’s an exception. |
| On Sunday, President Trump praised two of the nation’s largest health insurers, Cigna and Humana, for agreeing to waive out-of-pocket costs for treatment in some of their plans. | On Sunday, President Trump praised two of the nation’s largest health insurers, Cigna and Humana, for agreeing to waive out-of-pocket costs for treatment in some of their plans. |
| Two other major insurers, CVS Health’s Aetna and UnitedHealth Group, have also said they would cover their customers’ treatment costs. | Two other major insurers, CVS Health’s Aetna and UnitedHealth Group, have also said they would cover their customers’ treatment costs. |
| Other insurers are following suit: Florida Blue, the state’s big Blue Cross plan, is waiving cost sharing for some of its plans, including its Obamacare policies. Harvard Pilgrim, which insures people in Massachusetts, New Hampshire, Connecticut and Maine, is also eliminating out-of-pocket costs for Covid-19 treatment. | Other insurers are following suit: Florida Blue, the state’s big Blue Cross plan, is waiving cost sharing for some of its plans, including its Obamacare policies. Harvard Pilgrim, which insures people in Massachusetts, New Hampshire, Connecticut and Maine, is also eliminating out-of-pocket costs for Covid-19 treatment. |
| The Blue Cross and Blue Shield Federal Employee Program, which covers nearly six million federal employees, retirees and their families, previously said it would waive co-payments and deductibles for medically necessary treatment. | The Blue Cross and Blue Shield Federal Employee Program, which covers nearly six million federal employees, retirees and their families, previously said it would waive co-payments and deductibles for medically necessary treatment. |
| Different Blue Cross plans have different policies, and the situation is fluid, according to the B. | Different Blue Cross plans have different policies, and the situation is fluid, according to the B. |
| But a lot of fine print remains: Some of the insurers have waived cost sharing for the next two months, while others are eliminating out-of-pocket expenses only for hospital stays. Many require people to go to hospitals and doctors within their plans. | But a lot of fine print remains: Some of the insurers have waived cost sharing for the next two months, while others are eliminating out-of-pocket expenses only for hospital stays. Many require people to go to hospitals and doctors within their plans. |
| Another big caveat: The companies’ decisions also do not apply to the health plans they administer for employers that self-insure. Each of those companies will have to decide whether they will follow the insurers’ lead. A majority of workers with job-based coverage, 61 percent, are in self-funded plans, according to the Kaiser Family Foundation. That amounts to roughly 100 million people. | Another big caveat: The companies’ decisions also do not apply to the health plans they administer for employers that self-insure. Each of those companies will have to decide whether they will follow the insurers’ lead. A majority of workers with job-based coverage, 61 percent, are in self-funded plans, according to the Kaiser Family Foundation. That amounts to roughly 100 million people. |
| The federal government has also made it easier for people who have certain high-deductible plans. The Internal Revenue Service recently allowed people in those plans to have coronavirus testing and treatment covered by the plan before they meet their deductibles. | The federal government has also made it easier for people who have certain high-deductible plans. The Internal Revenue Service recently allowed people in those plans to have coronavirus testing and treatment covered by the plan before they meet their deductibles. |
| It’s hard to estimate how much you could owe if you don’t get a waiver, but the Kaiser Family Foundation provided some ballpark estimates for a pneumonia hospitalization and concluded that the total cost could be over $20,000 — with an individual’s out-of-pocket costs running around $1,300. All of those figures depend on what plan you have, where you get care and how serious a case you have. | It’s hard to estimate how much you could owe if you don’t get a waiver, but the Kaiser Family Foundation provided some ballpark estimates for a pneumonia hospitalization and concluded that the total cost could be over $20,000 — with an individual’s out-of-pocket costs running around $1,300. All of those figures depend on what plan you have, where you get care and how serious a case you have. |
| Updated July 22, 2020 | |
| No one knows whether employers, insurers or the federal government will eventually decide to completely cover these costs, although Joseph R. Biden Jr., the leading Democratic contender for president, has suggested providing emergency funds to cover treatment. | No one knows whether employers, insurers or the federal government will eventually decide to completely cover these costs, although Joseph R. Biden Jr., the leading Democratic contender for president, has suggested providing emergency funds to cover treatment. |
| And some hospital systems are putting a pause on collections. CommonSpirit Health, a Catholic chain of hospitals and clinics, says it is suspending patient billing for coronavirus testing and treatment as it sorts out how the various parties will handle patients’ out-of-pocket costs. | And some hospital systems are putting a pause on collections. CommonSpirit Health, a Catholic chain of hospitals and clinics, says it is suspending patient billing for coronavirus testing and treatment as it sorts out how the various parties will handle patients’ out-of-pocket costs. |
| You may be at risk if you get care from someone, like an emergency room doctor or anesthesiologist, who is out of your plan’s network, even if the hospital is in your network. When Kaiser did its analysis, it found that nearly one in five patients admitted to the hospital with a serious case of pneumonia faced out-of-network bills. | You may be at risk if you get care from someone, like an emergency room doctor or anesthesiologist, who is out of your plan’s network, even if the hospital is in your network. When Kaiser did its analysis, it found that nearly one in five patients admitted to the hospital with a serious case of pneumonia faced out-of-network bills. |
| Probably not. Even if they don’t like them, “insurers are used to surprises,” said Gregory Fann, an actuary at Axene Health Partners in Temecula, Calif. “That’s what they are there for.” | Probably not. Even if they don’t like them, “insurers are used to surprises,” said Gregory Fann, an actuary at Axene Health Partners in Temecula, Calif. “That’s what they are there for.” |
| Most insurers have plenty of capital, and state regulators also keep an eye on them to make sure the companies can pay their medical claims. | Most insurers have plenty of capital, and state regulators also keep an eye on them to make sure the companies can pay their medical claims. |
| And your premiums won’t go up during the current year — insurers set their prices for a whole year so you don’t have to worry about any immediate jumps in costs. But there are some predictions that next year’s premiums could soar if the pandemic adds tens of billions of dollars in costs that insurers and employers must pay. | And your premiums won’t go up during the current year — insurers set their prices for a whole year so you don’t have to worry about any immediate jumps in costs. But there are some predictions that next year’s premiums could soar if the pandemic adds tens of billions of dollars in costs that insurers and employers must pay. |
| It’s difficult to predict what will happen to businesses, which are under a lot of strain right now, and their ability to cover your medical claims. Companies that experience a surge in health care costs just as sales are plummeting could face a financial crisis that makes them unable to pay medical claims. | It’s difficult to predict what will happen to businesses, which are under a lot of strain right now, and their ability to cover your medical claims. Companies that experience a surge in health care costs just as sales are plummeting could face a financial crisis that makes them unable to pay medical claims. |
| You should be able to get covered. If you lose your job, you may qualify for Medicaid or be able to sign up for a health plan under the Affordable Care Act. | You should be able to get covered. If you lose your job, you may qualify for Medicaid or be able to sign up for a health plan under the Affordable Care Act. |
| A growing number of states are also creating a special enrollment period for residents who want to sign up, and there is even some talk of the federal government making a similar decision for the marketplaces they operate. There’s also talk of using the Medicaid program much more broadly to cover the uninsured. | A growing number of states are also creating a special enrollment period for residents who want to sign up, and there is even some talk of the federal government making a similar decision for the marketplaces they operate. There’s also talk of using the Medicaid program much more broadly to cover the uninsured. |
| “Don’t whip out your checkbook,” said Ms. Fish-Parcham, but she also warned that you shouldn’t ignore any medical bills. Contact your insurer as well as the hospital or doctor to find out if you really owe what they say you owe. Be sure to check with your state insurance department as well. You may have been billed in error. | “Don’t whip out your checkbook,” said Ms. Fish-Parcham, but she also warned that you shouldn’t ignore any medical bills. Contact your insurer as well as the hospital or doctor to find out if you really owe what they say you owe. Be sure to check with your state insurance department as well. You may have been billed in error. |