Health plans

Most Maine health plans no longer waive patient costs for COVID-19 treatment

Following a national trend, two of Maine’s largest health insurance providers – Anthem and Harvard Pilgrim – have stopped waiving out-of-pocket patient expenses such as deductibles and copayments for COVID-19-related treatments, this which means that patients hospitalized for the disease will likely pay a lot more.

Only one major insurer of Mainers, Community Health Options, said it plans to continue waiving these costs for patients until the end of the year, whether or not policyholders treated for COVID-19 are vaccinated.

According to vendor guidelines released this month, Anthem Inc. stopped waiving patient cost sharing for COVID-19 treatment at the end of January, while Harvard Pilgrim Health Care only recently stopped on August 7.

Kimberly Winn, senior communications specialist for Harvard Pilgrim, said it was one of the first health insurers in Maine and the region to announce cost-sharing waivers for COVID-19 treatment.

“(But) vaccines are now readily available, free, and are very effective in preventing hospitalizations for those who contract COVID-19,” Winn said in a statement.

The elimination of the waivers does not apply to Medicare patients in Maine, she said, as cost sharing for these patients will remain removed until the public health emergency ends.

Maine’s state of civil emergency ended on June 30, but the US Department of Health and Human Services extended the national public health emergency until at least October 17.

In Maine, the Lewiston-based Community Health Options provider is the only one still waiving deductibles and co-payments for all COVID-19-related treatments. Spokeswoman Kathleen Hayden said the company will revert to normal cost-sharing arrangements for all of its health plans in 2022.

Federal law requires all private insurance plans to cover the full cost of “medically appropriate” COVID-19 testing and that the US government have prepaid for COVID-19 vaccines so that the vaccine can be available free of charge, whether or not the beneficiary has health insurance.

Some states, such as Massachusetts, Rhode Island, and New Mexico, have imposed requirements that insurers waive out-of-pocket costs for COVID-19 treatment, but Maine is not one of them, and it there was no such federal mandate.

According to a report by the Kaiser Family Foundation and the Peterson Center on Healthcare, many insurance companies across the United States have voluntarily waived out-of-pocket expenses, including copayments and deductibles for COVID-19 treatment in stronger from the pandemic. But with the vaccines now widely available, many insurers are phasing out these waivers.

Analysis by Kaiser and Peterson found that of the two largest health plans in each state and Washington, DC, 72% are no longer waiving out-of-pocket expenses for COVID-19 treatment. Almost half of them stopped doing so by April at the latest.

Of the roughly 28% of major U.S. insurers that still waive patient fees, 10 are expected to end the policy by the end of October and 12 more are expected to do so by the end of the year.

The 102 plans reviewed represent 62% of all health insurance underwriting in fully insured individual and group markets, and all of those plans had waived cost-sharing of COVID-19 treatment at some point during the pandemic, according to the report. , published last week. on the Health Systems Tracker of both organizations.

COVID-19 cases have increased in Maine due to the more highly transmissible delta variant and a population that is still nearly 40% unvaccinated. Maine hospital officials on Thursday pleaded with the public to get vaccinated against the disease, saying hospitals across the state are now swelling with unvaccinated patients.

The state reported 415 new cases of COVID-19 on Saturday, the highest one-day total since May 3. Maine health officials reported the highest number of ICU patients with COVID-19 in Maine on Friday since the pandemic peaked last January.

The number of COVID-19 patients in intensive care units rose from 59 to 71 between Thursday and Friday. The only other time more than 70 people were in critical beds with COVID-19 in Maine was on January 20, when there were also 71 people in critical care.


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