As COVID-19 hospitalizations continue to stress Wisconsin’s health care system, insurance coverage for COVID-19 testing and treatment varies depending on the type of care and where it is received. Whether for testing, vaccination or medical procedures, consumers should consult with their insurance companies to make sure they know what is covered and what services might have some sort of cost sharing.
As recently reported
in The Valued Voice,
the Biden administration is now requiring health insurers to cover or reimburse the cost of up to eight at-home testing kits per month for their enrollees. Medically necessary testing ordered by an in-network provider is also typically covered with no cost-sharing. Likewise, most individual and group insurance plans are required by the Centers for Medicare & Medicaid Services (CMS) to cover vaccine administration, whether from an in-network or out-of-network provider.
But when it comes to medical costs for treating someone who has COVID-19, insurer policies vary. Some health plans cover monoclonal antibody treatments with no out-of-pocket costs, while others charge cost-sharing fees. Further, in 2020, many insurers waived cost-sharing for medical services such as an inpatient hospital stay for COVID-19, but most are now no longer waiving those cost-sharing requirements. An August 2021 report
from Kaiser Family Foundation indicated that many insurers were phasing out such waivers. There have also been reports that starting Jan. 1, even more insurers are applying cost-sharing to these services.
As hospitals throughout the state continue to provide the highest quality patient care, it is important that consumers know what to expect in terms of their insurance coverage, and they can do that by visiting their insurer’s website or by calling their insurance company.