Medicare, Medicaid, Health Insurance Providers and Uninsured All Cover COVID-19 Testing at No Cost to Patient

As a country, we are in a serious pandemic situation. The U.S. has 4% of the world’s population and yet 25% of the cases of the COVID-19 virus. Poor strategies in dealing with the virus has led to lack of concern for wearing masks, social distancing, and getting testing. It is critical for every American to know that they will be covered by their private insurance, Medicare Part B and Medicaid and that all uninsured individuals are covered for COVID-19 testing. Individuals that get COVID-19 testing will not have to pay any out of pocket nor will there be any surprise post-treatment bills. There is also no limitation on the number of times an individual can be tested. A primary goal to reduce transmission infection is to make sure that people are tested and eliminating fears and expenses is the prime directive that can move testing forward.

CARES Act and Families First

Action that was taken on April 11, 2020 regarding guaranteeing free COVID-19 testing for those insured privately, with Medicare or Medicaid involved HHS (the Departments of Health and Human Services), and Labor in a joint guidance for the implementation of coverage provisions for COVID-19 which resulted in the “Families First” (Families First Coronavirus Response) and CARES (Coronavirus Aid, Relief, and Economic Security). Both of the bills require that private health insurance plans cover the testing and related services of COVID-19 without any cost sharing. The coverage includes group health insurance plans that are employer supplied, individual health insurance policies (including grandfathered health plans), non-federal government plans, and church plans. Coverage details on the bills can be found with the government website pdf.

The CARES Act was created to expand coverage for testing beyond what was already FDA approved so that patients would not have any cost-sharing so that it included state-developed tests, testing provided by labs on an emergency basis, and any additional tests that were HHS-deemed appropriate.

The CARES Act Section 3701 also includes a “safe harbor” for the HDHP (high-deductible health plans) that may be used in conjunction with health savings accounts that begin on or before December 31, 2021 to so it provided pre-deductible coverage for remote care services including telehealth so that these services can be covered as pre-deductible so that it doesn’t violate federal HDHP federal rules.

Both of these laws are expected to last for around one year, however they will be in effect as long as there is a public health emergency as declared by the Secretary of HHS, which was originally designated for expiration on April 25, 20

Medicare, Medicaid, and the Uninsured

Those individuals covered by Medicare Part B health plan, Medicaid and those that are uninsured are completely covered for COVID-19 testing. It is anticipated that those without any form of health insurance make up around 10% of the population expected to receive COVID-19 testing.

According to the Medicare.gov COVID-19 testing website:

“Tests done to help your health care provider diagnose or rule out COVID-19. In some circumstances, a home health nurse, laboratory technician, or an appropriately-trained medical assistant may collect your specimen in your home for this test.”

When tests are available for you in your state, Medicare covers and you pay nothing for:

• Tests to diagnose or aid the diagnosis of COVID-19
• Some tests for related respiratory conditions to aid diagnosis of COVID-19 done together with the COVID-19 test
• Medicare covers these tests at different locations, including some “parking lot” test sites.
• Medicare also covers COVID-19 antibody tests, COVID-19 monoclonal antibody treatments, and COVID-19 vaccines

Testing Covered

Standard COVID-19 viral tests such as CareStart™ Covid-19 Rapid Antigen Test to see whether a patient has been infected as well as serological testing such as FaStep® Covid-19 Point-of-care Antibody Test that measures the level of antibodies that an individual may have as a response to the COVID-19 virus are both accepted forms of testing that are covered without any cost to the patient.

In addition to COVID-19 tests, other test screening for potential illnesses involving the respiratory system, such as the flu, must also be covered without any cost-sharing to the patient if provided during a visit that results in the administration of a COVID-19 test. This provision has been included based on the high request for clinicians to test for other respiratory illnesses prior to the COVID-19 test.

The services will be covered without any patient cost-sharing even when provided in what is referred to as a “non-traditional setting” such as drive-through testing centers. The specific details does not include whether the protection against cost-sharing extends to fees incurred due to a non-traditional location such a provider charging a facility fee.

To encourage both symptomatic and asymptomatic individuals to get COVID-19 testing, it bears repeating that there is no limit on the number of times a patient can be tested without any cost to the individual.