Public/Global Health

Coronavirus testing could cost some patients extra

The Trump administration’s efforts to scale up coronavirus testing in the U.S. could leave some patients with unexpected medical bills.

The federal government will rely heavily on commercial labs to run the vast majority of coronavirus tests. Those labs, along with hospitals and academic institutions, could bill patients and their insurance companies for testing.

How much each patient pays will ultimately depend on whether they have insurance, what kind of plan they have and whether it requires cost-sharing, like deductibles and copays.

“We have a patchwork quilt that’s full of holes that’s our health care system and it is not well-designed for dealing with a public health crisis like this one,” said Sabrina Corlette, a research professor at Georgetown University.

Patients in 18 states have tested positive for the coronavirus, bringing the total number of infections to 162, including 11 deaths. More cases are expected to be identified as labs ramp up testing in the coming days and weeks.

While lab tests completed by the Centers for Disease Control and Prevention (CDC) and public health labs are free to patients, those tests make up a small fraction of the testing that will be done for the coronavirus.

People without insurance might face out-of-pocket expenses for testing if it’s conducted by a commercial lab. People with high-deductible plans, which require patients spend a certain amount toward care before coverage kicks in, could also be hit with testing costs.

Studies have found that high-deductible health plans are linked to delayed diagnoses. The average deductible in an employer-based plan is about $1,650, while an ObamaCare bronze plan is about $6,000.

Those financial burdens could lead some people to forgo testing, potentially leading to further spread of the virus, experts said.

“As testing moves out of the public health sphere and into the private health care and insurance market, there are more avenues for unintended consequences,” said Adriane Casalotti, chief of government affairs for the National Association of County and City Health Officials. “Copays and deductibles are there to make you think twice about using health services, but we don’t want people to hesitate when it comes to public health.”

It’s not yet clear how much the commercial tests will cost, but it’s likely they will vary. Patients who are tested for the coronavirus might also face costs related to visiting the doctor, emergency room or urgent care. If they test positive and require hospitalization, they would face charges for that, too. 

Seema Verma, head of the Centers for Medicare and Medicaid Services, told reporters Thursday that Medicaid and Medicare would cover testing, likely without cost-sharing requirements.

But she acknowledged that people with private plans should ask their insurance companies if cost-sharing will be required.

“People should check with their insurance company. Like I said, this is a common type of test … most plans would cover this,” she said.

The Trump administration official also noted the test is free at public health departments, so “that is an option for people.”

However, public health labs make up a “tiny piece of the testing world,” the CDC’s Anne Schuchat told lawmakers this week.

“I think there remains an important question about what will be the cost to the insured individuals,” said Jennifer Tolbert, director of State Health Reform at the Kaiser Family Foundation, referring to the government health plans.

“I think how different health insurance plans decide to cover the test will affect how much individual consumers have to pay,” she added.

America’s Health Insurance Plans (AHIP), a national trade group representing health insurance companies, announced Thursday its members would voluntarily cover coronavirus testing ordered by doctors and “take action to ease network, referral and prior authorization requirements and/or waive patient cost-sharing.” But it did not provide more details about what that could look like. A spokesperson told The Hill “decisions will vary by health insurance provider.”

Governors in New York, Washington and California issued guidance this week prohibiting health insurers from imposing cost-sharing on individuals seeking coronavirus tests.

But all states are limited in what they can require of self-funded plans typically offered by large employers. More than 60 percent of people who get insurance through work are in these types of plans.

While employers can’t be required to cover the tests, Tolbert noted they might feel compelled to do so to prevent diseases from spreading in the workplace.

Lawmakers have been frustrated with the slow pace of testing in the U.S., raising concerns that the coronavirus is spreading undetected across the country.

To increase lab testing capacity, the Food and Drug Administration (FDA) released guidance last week allowing some commercial labs to develop and perform their own tests.

FDA Commissioner Stephen Hahn told lawmakers on Tuesday that one manufacturer expects to send kits that can perform up to 1 million tests to those labs by the end of this week. The commercial labs plan to begin testing in the coming days and weeks.

While the move is expected to vastly ramp up the capacity to test for the coronavirus, lawmakers and policymakers have not provided many details on how it will impact people who are uninsured or are underinsured.

The House on Wednesday passed a bipartisan measure providing $7.76 billion in emergency funding to help federal, state and local governments respond to the coronavirus. But the measure doesn’t include language on paying pay for vaccines for the uninsured or underinsured, a House appropriations spokesperson said.

“My understanding is that it does not deal with that yet. That’s a big issue of how to deal with that,” said Rep. Pramila Jayapal (D-Wash.), whose state has had 10 of the 11 deaths in the U.S. from the coronavirus.

She said the availability of testing for people without insurance, and those who are underinsured, is a “huge concern.”

“We should be doing [testing] far more aggressively and we should be doing it in a way that’s really free and for everyone because this is a potential pandemic,” said Rep. Mark Pocan (D-Wis.), a member of the House Appropriations Committee.

Congress may address the issue of tests and treatment for the coronavirus in future spending bills, by potentially compensating hospitals that care for the uninsured.

The administration has also floated the idea of using a national disaster program to compensate hospitals that care for uninsured coronavirus patients. But it’s not clear how that would impact patients who are insured but have high deductibles or other cost-sharing requirements.

Democrats and health advocates have expressed concern about people who are insured through short-term plans that cover few benefits. Those plans have been expanded by the Trump administration.

“The short-term plans that have been pushed by this administration as an alternative to fully-compliant [Affordable Care Act] plans may not cover services like this at all,” said Cheryl Fish-Parcham, director of access initiatives at the consumer group Families USA.

Updated at 5:20 pm.

Tags CDC Coronavirus Mark Pocan Nancy Pelosi Pramila Jayapal testing Washington
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