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You are healthy now, but will your insurance pay for testing and treatment?

Will my health insurance cover the costs of coronavirus testing and treatment?

Health insurance & health reform authority

March 25, 2020

Key takeaways

Q: Will my health insurance cover the costs of coronavirus testing and treatment?

A: The novel coronavirus – and the COVID-19 disease it causes – have dominated headlines for several weeks, and have triggered a massive public health response in the United States. A common question that people have, even if they’re only mildly concerned about the pandemic, is “How will my health insurance cover the coronavirus?” The short answer? It depends. With the exception of Original Medicare, health insurance differs greatly in the U.S., depending on where you live and how you obtain your coverage. Including the District of Columbia, there are 51 different sets of state insurance rules, separate rules that apply to self-insured group plans (which are not regulated by the states), and 51 different Medicaid/CHIP programs.

Nearly half of all Americans – including a large majority of non-elderly Americans – get their health coverage from an employer. Those plans are regulated by a combination of state and federal rules, depending on the size of the group and whether it’s self-insured or fully-insured.

And about 6 percent of Americans buy their own health insurance in the individual market, where both state and federal rules apply. Is testing for COVID-19 covered by health plans?

Under the terms of the Families First Coronavirus Response Act (H.R.6201), Medicare, Medicaid, and private health insurance plans – including grandfathered plans – are required to fully cover the cost of COVID-19 testing, without any cost-sharing or prior-authorization requirements, for the duration of the emergency period. That includes the cost of the lab services as well as the provider fee at a doctor’s office, urgent care clinic, or emergency room where the test is administered. Since it’s a federal law, the requirements apply to both self-insured and fully-insured health plans, whereas the testing coverage requirements that numerous states have imposed (details here and here) are only applicable to fully insured plans.



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