States Act to Remove Barriers to Virus Testing

Deductibles, co-payments, and co-insurance.
March 10, 2020

Cost sharing, such as the use of deductibles, co-payments, and co-insurance, can be too costly for some patients. But at times when the risk of flu, coronavirus, and the like are high, many patients may opt to forgo care because they have not yet met their deductibles and cannot afford their out-of-pocket costs. This is causing an increasing number of states to take action in the wake of the coronavirus.

Oregon: Gov. Kate Brown announced that the state has reached an agreement with health insurance companies to waive cost-sharing for patients who test for COVID-19, which means that people with insurance and group health plans won't face co-payments, co-insurance, or deductibles for COVID-19 testing at in-network health care providers or emergency rooms. It will also cover immunization for covered people when that becomes available

Nevada: Gov. Steve Sisolak adopted an emergency regulation. This regulation addresses the following three issues: No cost for medical services related to testing for COVID-19; information to members and providers about insurance benefits, medical service options, and preventative measures; and coverage for off-formulary prescriptions if pharmacy supplies are disrupted.

Commissioner of Insurance Mark Afable issued a bulletin that outlines a series of measures that insurers, self-funded plans, pharmacy benefit managers, and cooperative health plans are being requested to take in order to help meet the current public health challenge posed by COVID-19, including reviewing their current state of readiness to respond to any new COVID-19 cases; waiving cost-sharing for COVID-19 laboratory and radiology testing; and verifying that their provider networks are prepared to respond to a possible increase in the need for health care services in the event more COVID-19 cases are diagnosed in Wisconsin.

Washington: Insurance Commissioner Mike Kreidler issued an emergency order to Washington state health insurers requiring them to waive copays and deductibles for any consumer requiring testing for coronavirus (COVID-19). Insurers also must allow a one-time early refill for prescription drugs and suspend any prior authorization requirement for treatment or testing of COVID-19. In addition, if an insurer does not have enough medical providers in its network to provide testing and treatment for COVID-19, it must allow enrollees to be treated by another provider within a reasonable distance at no additional cost.

New York: Gov. Andrew Cuomo recently announced that New York insurers should waive cost-sharing for coronavirus testing.

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