Health plans

Health plans phase out cost-sharing exemptions for COVID treatment

Although a handful of states have required or created agreements with insurers to waive COVID-19 treatment fees for their fully insured plan members, there is no federal mandate that requires insurers to do so. (Photo: Shutterstock)

Nearly three-quarters of the nation’s largest health plans are no longer forgoing cost-sharing of COVID-19 treatment, the Peterson-KFF Health System Tracker reported.

Federal law requires all private insurance plans to cover the full costs associated with approved COVID-19 tests as long as the test is deemed medically appropriate. Additionally, the U.S. government prepaid for the COVID-19 vaccines and demanded that they be available at no outlay whether or not the recipient of the vaccine is insured. However, while a handful of states have required or created agreements with insurers to waive COVID-19 treatment fees for their fully insured plan members, there is no federal mandate for insurers to do so.

Related: Insurers End Telehealth Cost Sharing Exemptions

Kaiser's Table of Insurance Coverage for COVID

In recent months, the environment has changed, with safe and highly effective vaccines now widely available. According to the latest statistics:

  • 72% of the two largest insurers in each state and District of Columbia are no longer waiving these costs, and an additional 10% of plans will phase out waivers by the end of October.
  • Almost half of those plans ended cost-sharing waivers by April 2021, around the time most states opened up vaccinations to all adults.
  • Of the 29 plans still forgoing cost-sharing for COVID-19 treatment, 10 waivers are expected to expire by the end of October.
  • Twelve other plans have said their cost-sharing waivers will expire by the end of 2021.
  • Two plans have specified end dates for COVID-19 treatment waivers in 2022, and five plans have not specified an expiration date.

“Earlier in the pandemic, relatively few COVID-19 patients would have been billed for their hospitalization due to voluntary waivers granted by private insurers and employers,” the report concludes. “But as vaccines have become widely available for adults in the United States, and healthcare use has rebounded more generally, health insurers may no longer face political or public relations pressure to continue to forgo COVID-19 treatment costs. As more waivers expire, more people hospitalized with COVID-19 – the vast majority of whom are not vaccinated – will likely receive significant medical bills for their treatment. “

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