Insurers, Federal Government Working to Control Out-of-Pocket Costs Amid COVID-19 Pandemic

In addition to governmental measures to mitigate costs, members of America’s Health Insurance Plans (AHIP), which include Cigna Corp and Aetna, will take steps to ensure affordable access to novel coronavirus (COVID-19) testing and treatment, according to a statement from the company.¹

In addition to the typical co-pays and costs for a physician visit, patients who need testing for COVID-19 could face steeper costs depending on whether the test is run by a commercial lab or the CDC.²

According to a report from the Kaiser Family Foundation, nearly 28 million nonelderly Americans lacked health insurance in 2018, which could be a major barrier to accessing necessary diagnostic testing and treatment for COVID-19.² More than half of those uninsured patients do not have a regular physician’s office to visit when they need medical care, and 1 in 5 uninsured adults went without necessary medical care due to costs in 2018.²

Furthermore, those who seek medical care without insurance will face large medical bills. According to the report, uninsured people may pay higher rates than those with insurance whose coverage negotiates lower rates than normal, further dissuading those patients from seeking care.²

“Fear of large and unaffordable medical bills can deter uninsured individuals from getting the care they need,” the report said. “In the context of a public health emergency, decisions to forego care because of costs can have devastating consequences.”²

Some insurance companies, however, are taking steps to mitigate those costs. Blue Cross Blue Shield (BCBS), for example, is waiving prior authorizations (PAs) for diagnostic tests, covering medically necessary diagnostic tests, waiving early medication refill limits on 30-day prescription maintenance medications, and expanding access to telehealth and medical provider hotlines.³

“BCBS is making these changes to ensure its members can swiftly access the right care in the right setting during the outbreak,” the company said in a statement.³

AHIP has focused on similar measures encompassed in 3 steps, according to a press release. Those steps include working with public- and private-sector partners to find solutions to out-of-pocket costs, partnering with health care providers to ensure the availability of treatment, and educating the public on preventive measures.¹

Part of implementing solutions includes easing network, referral, and PA requirements for necessary diagnostic testing when ordered by a physician, as well as taking steps to ensure that patients have continued access to regular medications, according to the statement.¹

AHIP members are also working with health providers to encourage telehealth, at-home care, and other technology-based options for patients who should not leave their homes.¹

As part of these measures, Aetna has announced $0 co-pays for telemedicine visits until June 4, waived co-pays for all COVID-19 testing, and free home delivery of prescriptions from CVS pharmacies.⁴ Similarly, Cigna has waived customer cost-sharing for telehealth screenings, in addition to offering extra resources for patients looking to be treated virtually for routine medical examinations.⁵

Some federal legislation may also mitigate costs, according to the Kaiser Family Foundation report. The Families First Coronavirus Response Act, passed March 13, would give states the option to expand Medicaid coverage to include uninsured individuals in their state for COVID-19 diagnosis and testing. This expansion would have 100% federal financing if implemented.

Although this step only includes testing, the report noted that it requires state Medicaid programs to cover the tests with no cost sharing, which could go a long way toward ensuring more widespread testing.²

REFERENCES

• Statement by The AHIP Board of Directors: Taking Action to Address Coronavirus COVID-19 [news release]. America’s Health Insurance Plans; March 5, 2020. https://www.ahip.org/statement-by-the-ahip-board-of-directors-taking-action-to-address-coronavirus-covid-19/. Accessed March 18, 2020.
• Tolbert, J. What Issues Will Uninsured People Face with Testing and Treatment for COVID-19? Kaiser Family Foundation; March 16, 2020. https://www.kff.org/uninsured/fact-sheet/what-issues-will-uninsured-people-face-with-testing-and-treatment-for-covid-19/. Accessed March 18, 2020.
• Coronavirus Updates [news release]. Blue Cross Blue Shield, https://www.bcbs.com/coronavirus-updates. Accessed March 18, 2020.
• Coronavirus: We’re here to help. Aetna; https://www.aetna.com/individuals-families/member-rights-resources/covid19.html. Accessed March 18, 2020.
• Cigna Takes Additional Actions to Protect Customers and Communities Against COVID-19 [news release]. Cigna; March 13, 2020. https://www.cigna.com/newsroom/news-releases/2020/cigna-takes-additional-actions-to-protect-customers-and-communities-against-covid-19. Accessed March 18, 2020.