News 3/23/2020

Wall Street Journal: What Will Coronavirus Testing and Treatment Cost Me?

If you’re seeking testing or treatment for the new coronavirus, your first concern is your health. But many Americans have another worry after that: What’s this going to cost me? Here are some answers.

Is coronavirus testing free?

Yes, most of the time. The newest coronavirus legislation will force health insurers and employers to cover lab tests for the new coronavirus and visits to health-care providers for screening—without any out-of-pocket charges.

If you have private insurance, you generally shouldn’t have to pay anything if you go to a doctor’s office or a hospital in your insurance network to get tested for the virus. It should be covered on a first-dollar basis, meaning you shouldn’t be charged even if you haven’t maxed out your deductible for the year. And that is supposed to include other tests needed to help diagnose Covid-19, the respiratory illness tied to the coronavirus.

But there are some gaps. Your visit is free only if it results in a coronavirus test. If a doctor does procedures or tests to rule out the new virus and ends up not ordering a lab test for it, then you might still be on the hook for your copay or deductible.

“Don’t just go in. Call ahead” before you go, says Karen Pollitz, a senior fellow with the Kaiser Family Foundation. In some states, coronavirus testing is still limited, so you may find that you don’t qualify.

The law also includes money to pay for coronavirus testing for the uninsured.

If I need treatment for Covid-19, will that be free?

Nope. The new legislation doesn’t guarantee that your health insurer will cover your treatment free of cost. For that, your typical plan rules will likely apply—meaning, you’ll have to pay until you hit your deductible, or you’ll owe a copay or coinsurance, which is a percentage of the cost of treatment.

The Internal Revenue Service recently announced that, in high-deductible plans paired with tax-advantaged accounts, insurers and employers could cover Covid-19 testing and treatment without cost-sharing, even before a patient has gotten through the deductible.

Julie Stone, a managing director at insurance advisory firm Willis Towers Watson, says some employers may choose to cover both treatment and testing with no cost-sharing, but many won’t.

For the uninsured, the new law doesn’t include money to pay for Covid-19 treatment. They could potentially face large bills down the line, depending on the policies of the doctor or hospital involved.

How much is Covid-19 treatment likely to cost?

For many, it’ll likely just take the cost of some fluids, cough medicine and over-the-counter medicines for fever and pain. By some estimates, around 80% of those who are infected have few or moderate symptoms.

But for some who get more seriously ill, the cost could be huge—though it should be largely covered by insurance. The Kaiser Family Foundation estimated that in employer plans, the total cost of a hospital admission for pneumonia with major complications was more than $20,000 on average, and the average out-of-pocket cost for the patient was about $1,300. Even without any complications or comorbidities, the average cost was $9,763, and the average charge to the patient was $1,464.

What about surprise bills for treatment?

Surprise bills could definitely hit patients who go to hospitals, doctors or labs that aren’t in their insurers’ networks for Covid-19 treatment. Some states have protections against such bills, but there is no shield at the federal level, and there is nothing in the new coronavirus law that bans surprise bills.

The new law is supposed to ensure that coronavirus testing and screening visits are free, but it specifically bans only cost-sharing such as copayments. Doctors could still potentially bill you for the difference between what your insurer pays and their total charges. That is also true for out-of-network labs.

And if you are getting treated for Covid-19, you could easily get surprise bills from out-of-network specialists who see you while you’re in the hospital. The Kaiser Family Foundation estimated that 18% of patients who are admitted to an in-network hospital for pneumonia with complications could face surprise charges.

“It’s just like if you had any other illness,” said Kim Buckey, a vice president at DirectPath LLC, which advises employees on health costs. People who are admitted to hospitals for Covid-19 treatment would likely be seen by specialists such as pulmonologists and anesthesiologists, she said, and “specialists in general are a category of providers that are often out of network.”

What about Medicare and Medicaid?

For coronavirus testing, and a health-care visit that results in a test, beneficiaries enrolled in Medicare shouldn’t have to pay any out-of-pocket charges under the new law.

But for treatment of Covid-19, they could have to pay the usual out-of-pocket charges. In Medicare, enrollees typically owe a deductible, and they pay 20% cost-sharing on outpatient care.

Medicaid has few out-of-pocket costs for anything.

What if I lose my job—and my health insurance?

Losing your job should qualify you for a special enrollment period to sign up for an Affordable Care Act plan, and if you have little or no income, you are likely to get federal subsidies that will cover much of the cost of premiums.

You also may qualify for Medicaid coverage, which is free. Eligibility varies by state.

You can also tap Cobra to keep your employer plan. But this tends to be very costly, generally 102% of the cost of the plan. The average annual family premium for employer plans last year was $20,576, and for an individual plan was $7,188, according to a Kaiser Family Foundation survey.

“It lets you continue your coverage as-is, except you have to pay the entire premium,” said Ms. Pollitz of the Kaiser Family Foundation. But it may be worthwhile if you are in the middle of treatment for something, she said. “If you like what you have, you can keep it.”


Read the article here.

(Anna Wilde Mathews covers health insurance for the Wall Street Journal. )

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