The coronavirus relief legislation passed by Congress in March, and April guidance from the Trump administration agreed that patients should not be burdened with payments for COVID testing and treatment that is “medically appropriate.”
But as the pandemic has evolved and grown, the definition of that term has both broadened and become fuzzier.
Early on in the coronavirus pandemic – when scarce COVID testing was limited to those with serious symptoms or serious exposure – the government and insurers vowed that tests would be dispensed for free (with no copays, deductibles or other out-of-pocket expense) to ensure that those in need had ready access. Now, those promises are being rolled back in ways that are creating turmoil for consumers, even as testing has become more plentiful.
Late last month, the Trump administration issued guidance saying insurers had to waive patient costs only for “medically appropriate” tests “primarily intended for individualized diagnosis or treatment of COVID-19.” It made clear that insurers do not have to fully waive cost sharing for screening tests, even when required for employees returning to work.
Who pays when all employees are required to have a negative COVID test in order to return to work?
What is clear: Insurers will be making judgement calls – likely on a case by case basis about how they will handle cost sharing for screening tests under the new Trump administration guidelines.