As the virus continues to spread within the United States, questions began to arise about whether and how coronavirus-related testing and treatment would be covered by public and private health insurers. The concern is that potential costs may prevent those patients who may need testing, from pursuing testing.
The largest health insurers voluntarily pledged to cover COVID-19 testing without cost sharing, though without a uniform standard this may lead to confusion and lack of consistency. In addition, some state governments quickly began passing legislation requiring health insurers to cover testing without cost sharing. On March 18, 2020, the Families First Coronavirus Response Act was signed into law. The Act addresses a number of items, including mandating that diagnostic testing for the coronavirus be covered without any cost sharing or prior-authorization. This would also apply to state Medicare, Medicare Advantage, Medicaid and Children’s Health Insurance Programs plans.
Initially, major health insurance carriers had not agreed to waive cost sharing for treatment of the virus (1). However, on March 25, 2020, CVS Health/Aetna announced they will waive cost sharing for COVID-19 treatment for Aetna-insured commercial plan sponsors effective immediately for any such admission through June 1, 2020. Shortly after, Cigna and Humana also agreed to waive cost sharing for treatment. At this time, it appears that all major carriers have agreed to waive cost sharing associated with COVID-19 treatment.
The elimination of cost sharing for COVID-19 testing pertains primarily to how those items will be handled in the primary insurance market, but what about handling within reinsurance coverage? While the cost of testing is minimal compare to typical retentions, at least one reinsurer (and we hope others to follow) has agreed to cover the additional plan costs associated with cost share waivers. However, especially for quota share and aggregate coverage, health insurers should verify that their reinsurance coverage will align with any changes in the underlying coverage provisions.