The Coronavirus pandemic has caused upheaval not just for the residents, but also for health insurance providers in the United States. Insurers now have to decide what is covered and what isn’t under their health plans. Many are unable to get back to work because they are uninsured, have insufficient coverage or perhaps not able to afford frequent tests. The high costs of healthcare and lack of publicly funded health insurance make most employees dependent on employer sponsored insurance. Millions have lost their jobs during the pandemic, also losing their insurance coverage at a time when health coverage is especially crucial. People who are uninsured face even greater barriers to seeking medical care as it eats into their savings.

Who is covered?

The Families First Coronavirus Response Act (FFCRA) passed by Congress requires health plans to fully pay for testing deemed medically necessary, i.e, if you are having symptoms, or you have had suspected or direct exposure or you need testing for surgical clearance, insurance will cover all of the testing and office visit. This will apply only if you’ve been referred for a test by a healthcare professional.

Government programmes like Medicare cover tests for Covid-19 at no costs if you have symptoms and if the test is ordered by your doctor or health care provider. If you’re asymptomatic, costs are covered if the test is ordered by a healthcare professional or if you are a resident or patient in a nursing home. Nursing homes are required to test their staff every week to ensure safety of its occupants. Public health researchers emphasize the importance of repeatedly testing nursing home residents and employees, as well as other asymptomatic, but high-risk people. Those who have lost their jobs due to Covid-19 still have coverage options under the Consolidated Omnibus Budget reconciliation Act (COBRA) and Medicaid.

Who is not covered?

As precautionary testing has become common, insurance companies argue that they won’t be able to cover testing as a preventive measure. Testing is considered not medically necessary when performed for public screening purposes to determine the prevalence of Covid-19 infection in the community, congregate settings or other viral diseases.

Insurance companies like UnitedHealthcare, state that benefits will be decided in accordance with the member’s benefit plan. When the tests are not diagnostic or medically necessary, insurers guarantee that they will cover testing for employment, education, public health or surveillance purposes when applicable by law. Currently testing in these settings is not required by law. What concerns insurance companies is that employers might initiate testing for everyone getting back to work. If it is passed as a law and if the government doesn’t intervene, it would cost health care insurers $25 billion a year. 

The Equal Employment Opportunity Commission has issued a statement saying that employers can legally require testing. However, this has not been implemented by many so far. Most just opt for temperature checks and questionnaires about symptoms, exposures and past travels. Insurers like Cigna and others do not cover testing for return-to-work, return-to-school, participation in sports, pre-employment, routine and/or executive physicals, travel, recruitment to armed forces, insurance purposes, disability evaluation and administrative exams.

Pressure is now mounting on insurers, employers and consumers. While insurers argue that the employers should cover the cost of testing, employers claim that they themselves are struggling financially and will not be able to do so. On the other hand, the workers also cannot afford testing especially if it has to be done frequently. 

Check out the Buckhead Medicine website and read our blogs and articles for more information regarding Covid-19. Read about how to get a Covid test if you don’t have health insurance. If you’re going home for the holidays, read our blog on precautions that you can take.