Health Insurance Coverage Changes Related to COVID-19

In response to the ongoing COVID-19 pandemic, the federal government has enacted two economic relief bills (the CARES Act and Families First Act) which mandate that group health plans and individual health insurers cover (without cost-sharing) COVID-19 testing and certain medical services which result in an order for COVID-19 testing. While this is a welcome first step to ensuring patients are adequately covered during the pandemic, many state governments have taken the initiative and issued guidance requiring insurers to provide coverage beyond the federal standard. These actions may impact your own coverage in the following ways: 

      • COVID-19 Testing Coverage that Exceeds the Federal Standard: Some states have ordered insurers to reduce or eliminate cost-sharing for services associated with COVID-19 testing that are not addressed by the federal legislation. For example, Washington and New Mexico are requiring that insurers cover testing for illnesses, such as influenza, that present COVID-19 like symptoms and are likely to result in an order for COVID-19 testing.


      • Lowering cost-sharing for COVID-19 treatment: A handful of states have gone beyond mandating access to testing by requiring coverage of treatment for COVID-19. For example, Massachusetts has issued guidance directing insurers to waive co-payment for all COVID-19 medical services, including those rendered by an out-of-network healthcare provider.


      • Early prescription refills: Because patients may be asked to self-isolate on short notice, many states are requiring that insurers cover early prescription refills so that individuals do not experience a disruption to their ongoing treatment.


      • Special enrollment period for uninsured individuals: Many states have extended their special enrollment period to allow uninsured individuals to obtain coverage. Some of these special enrollment periods will expire soon, so if you or a loved one is uninsured, please check to see if your state has extended or reopened their special enrollment period.


      • Premium grace periods: As businesses abide by public health measures mandating social distancing, many employees will experience financial hardship without regularly scheduled employment. In response to this, many states are requiring insurers to extend their premium payment grace periods or are issuing moratoriums on policy cancellation for non-payment.


      • Off-formulary drug coverage: Due to the potential for shortages of certain prescription drugs, state leaders are requiring insurers provide coverage for substituted drugs that are off of the insurer’s formulary. 


Triage Cancer has compiled a chart detailing which states have issued executive orders or otherwise required one or more of the above actions. Check here to see if your state is among them and how your coverage may be impacted. Please note that this information is changing frequently, so please make sure to get the latest information directly from these resources.

Even if your state is not on the chart, you may still be eligible to receive one or more of the listed benefits. Some states which have yet to mandate any of the above actions are issuing guidance “requesting” or “expecting” that insurers will take these steps to provide access to necessary testing and treatment. Further, many insurers have voluntarily elected to take such measures. America’s Health Insurance Plans is maintaining a list of which insurance providers are taking voluntary measures to reduce or waive cost-sharing, among other steps, for their enrollees. Your group health provider or individual health insurer may be among them, so be sure to check to see if you are eligible for any of the benefits listed above.

For more information about Key Changes to Insurance, Finances, & Work During COVID-19 watch the recorded webinar by Triage Cancer CEO, Joanna Morales, Esq.

Note: Triage Cancer would like to extend a special thanks to Zach Outzen, a J.D. candidate at William & Mary Law School, for his contributions to this content.  

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