CMS requires insurers to waive cost-sharing for COVID-19 diagnostic, antibody testing

  • Small
  • Medium
  • Large

CMS released a guidance April 11 that outlines the Trump administration's new COVID-19 coverage requirements for private health plans.

Five things to know:

1. In March, several national insurers committed to paying for diagnostic testing for COVID-19 without cost-sharing like copays and coinsurance — and many have since said they'll waive cost-sharing for inpatient treatment as well. The April 11 guidance implements the Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act, which requires private health plans and employer group health plans to cover COVID-19 testing with no out-of-pocket expenses.

2. The coverage requirement includes no cost-sharing for "certain related items and services" provided during a medical visit for COVID-19 testing. CMS said this means insurers must cover urgent care visits, emergency room visits and in-person or telehealth visits that result in an order for a COVID-19 test.

3. Additionally, the guidance ensures coverage of COVID-19 antibody testing. CMS said it sees the antibody test as a "key element in fighting the pandemic by providing a more accurate measure of how many people have been infected and potentially enabling Americans to get back to work more quickly."

4. The requirement is retroactive for testing and related services provided on or after March 18. It is unclear if the provisions, like ensuring free access to antibody testing, pertain to people who don't have insurance.

5. The requirement does not apply to short-term health plans.

Read the full guidance here.

More articles on payers:
UnitedHealth fast-tracks $2B in payments to providers
CMS finalizes 2021 Medicare Advantage rates: 5 things to know
Blue Shield of California to help hospitals get cash quicker


Copyright © 2021 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Whitepapers

Featured Webinars