Resources for Health Insurers
This page will be updated continuously to reflect the most recent information. This page was last updated on April 1, 2020.
The Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security (CARES) Act include requirements for insurance coverage of diagnostic testing for the coronavirus (COVID-19) and other services.
The Families First Coronavirus Response Act requires health insurers to cover the COVID-19 diagnostic test at no cost to individuals. This includes private health plans, Medicare, Medicare Advantage, Medicaid, CHIP, TRICARE, veterans’ plans, federal workers’ health plans, and the Indian Health Service.
- Plans may not use tools like prior authorization to limit access to the test.
- Insurers must also cover the cost, without cost-sharing, of a patient’s visit to a provider, urgent care center, or emergency room to receive this testing.
- This means that individuals are not responsible for deductibles, coinsurance, or co-pays for a COVID-19 test or for the visit associated with receiving that test.
- Please note that a doctor’s order is currently required to receive a COVID-19 test in Hawaii.
Pricing of Diagnostic Testing
For COVID-19 testing, the CARES Act requires insurers to pay either the rate specified in a contract between the provider and the insurer, or, if there is no contract, a cash price posted by the provider. Insurers may negotiate a lower price than cash price.
Vaccine Coverage (When Available)
There is not yet a vaccine available to prevent COVID-19.
When a COVID-19 vaccine is available, for private insurance, the CARES Act requires that private insurance coverage without cost-sharing begin fifteen days after a favorable rating or recommendation from the United States Preventive Services Task Force or the Advisory Committee on Immunization Practices.
The CARES Act requires a vaccine and its administration to be free to beneficiaries with Medicare Part B and those with Medicare Advantage who receive the vaccine from an in-network provider.
Medicaid and CHIP must cover recommended vaccines for children without cost-sharing. For adults in Hawaii, Medicaid must cover vaccinations without cost sharing. For other groups eligible for Medicaid, such as low-income parents, states have flexibility to determine whether to provide coverage of vaccines. Please contact Med-QUEST for more information on vaccine coverage.
Prescription Drug Coverage for Medicare Beneficiaries
During the COVID-19 public health emergency, Medicare Part D plans may permit seniors on Medicare to receive up to 90 days of a prescription if that is what their doctor prescribed, as long as there are no safety concerns. Medicare drug plans may also allow beneficiaries to fill prescription early for refills up to 90 days, depending on the prescription.
Over-the-Counter Medical Products
The CARES Act allows patients to use funds in Flexible Spending Accounts (FSAs), Health Savings Accounts (HSAs), and Health Reimbursement Arrangement (HRAs) for the purchase of over-the-counter medical products, such as non-prescription pain relievers and cold/flu medications, without a prescription from a physician. In addition, menstrual care products have been added to the list of qualified health care expenses under FSAs, HSAs, and HRAs.
The CARES Act provides new options to use telehealth. For more information, click here.
The CARES Act allows for high-deductible health plans with a health savings account to cover telehealth services prior to a patient reaching their deductible.
HHS will not take enforcement action against any health insurance issuer that amends its catastrophic plans to provide pre-deductible coverage for services associated with the diagnosis and/or treatment of COVID-19.
CMS has posted several guidance documents and other information at this link. Of particular note are the following:
- Medicaid and CHIP - Coverage and Benefits Related to COVID-19
- Individual and Small Group Market—
- Individual and Small Group Market Insurance Coverage – Information Related to COVID-19
- Payment and Grace Period Flexibilities Associated with the COVID-19 National Emergency
- FAQs on Availability and Usage of Telehealth Services through Private Health Insurance Coverage in Response to Coronavirus Disease 2019
- FAQs on Prescription Drugs and the Coronavirus Disease 2019 for Issuers Offering Health Insurance Coverage in the Individual and Small Group Markets
- FAQs on Catastrophic Plan Coverage and the Coronavirus Disease 2019
- FAQs on Essential Health Benefit Coverage and the Coronavirus
- Information for Medicare Advantage Organizations, Part D Sponsors, and Medicare-Medicaid Plans