August 14, 2020

Cost-Sharing for COVID-19 Testing and Treatment Based on Type of Payor

Enacted only nine days after the Families First Coronavirus Response Act required coverage for COVID-19 testing, the CARES Act preempted ERISA by requiring all health plans, including self-funded plans, to cover the costs of testing related to COVID-19, even if the testing was not performed by an in-network provider.  In addition, the CARES Act differentiates between testing and treatment.  For COVID-19 testing, those covered under employer, exchange, Medicaid, CHIP or Medicare plans will pay nothing out of pocket.  For the uninsured, the patient may have to pay the full cost of the test.  For COVID-19 treatment, those covered under employer or exchange plans may have a deductible or co-pay depending on the state.  Those covered under Medicare plans may have some financial responsibility with both traditional and MAO plans.  Those covered under Medicaid and CHIP plans will pay nothing out of pocket, but the federal government may match the increased Medicaid rate up to 6.2%.  Finally, for the uninsured, again, they may be faced paying full price.