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[FAQ] Health insurance and coronavirus
Below are some frequently asked questions provided by the Washington State Office of the Insurance Commissioner via its website.
Q: Will my insurance cover testing and treatment for coronavirus?
A: Yes. Most health insurance plans will cover testing and treatment for medically necessary services related to coronavirus. The office’s Commissioner Mike Kreidler has ordered all health plans his office regulates to waive copays, coinsurance and deductibles for people requiring testing (doh.wa.gov) for the virus. If you are concerned about whether you should be tested, read the guidance from the Washington State Department of Health and call your providers first. Copays and deductibles will still apply if you need treatment.
The Centers for Disease Control and Prevention is updating its recommendations (www.cdc.gov) for who should be tested.
If you are a member of a health sharing ministry, your coverage may be limited. Check the language of your coverage to understand what’s covered and what’s excluded.
Q: Is testing free? Is the patient exam free?
A: Kreidler has ordered all health plans regulated by his office to cover testing for coronavirus and the associated office visit without coinsurance, copays or deductibles from March 5-May 4, 2020. This includes drive-up testing, as well as any additional medically necessary testing for the flu or certain other tests for viral respiratory illnesses billed during the visit. State-regulated health plans include individual health plans, small employer health plans and some large employer plans.
Before you show up at your provider’s office, make sure you have the symptoms necessary for testing (doh.wa.gov) (the criteria are changing as more tests become available) and contact your provider’s office first.
Q: Will my health insurer waive my deductible because this has been declared an emergency?
Kreidler has instructed all state-regulated health plans (PDF, 251KB) to waive coinsurance, deductibles and copays for people who need testing for coronavirus. State law gives him the authority (leg.wa.gov) to do so once the governor has issued an emergency proclamation. The waiver applies to the testing for coronavirus and the provider visit to order the testing, including drive-up testing, as well as any additional medically necessary testing for the flu and certain other viral respiratory illnesses billed during the visit.
Q: What if I have a high-deductible health plan with a health-savings account?
A: The co-pay, coinsurance and deductible waiver for coronavirus testing also applies to all high-deductible health plans with qualifying health savings accounts, according to guidance from the IRS (PDF, 27KB).
Q: What guidance are you giving to health insurers, if any?
A: We are telling all state-regulated health insurers to waive copays, coinsurance and deductibles for enrollees who need testing for coronavirus. This applies to the test itself and the provider visit, including drive-up testing. Also, the office is telling health insurers to:
- Not require any prior approval for testing or treatment of coronavirus.
- Allow a one-time early refill for prescriptions.
- Allow enrollees to see out-of-network providers for testing and treatment with no additional costs, if the insurer doesn’t have enough in-network providers to meet demand.
- Expand coverage for additional methods for providing telehealth services, including telephone and other video services.
- Temporarily postpone cancellations and non-renewals of health coverage.
- Include coverage with no coinsurance for other medically necessary testing for viral respiratory illnesses during the coronavirus visit.
- Allow at least 60-day premium grace periods for people who do not qualify for a subsidy through our exchange and for people in plans sold outside of the exchange or in small or large employer plans that are regulated by the state.
- Waive or speed up prior authorization for home health services and long-term care facilities to expedite patients being discharged from a hospital.
Q: Will my health plan allow me to refill my prescriptions early so I can have a 30-day supply on hand?
A: The commissioner has instructed health plans to allow for one-time early refill for most prescriptions. You should check with your health plan if you have questions about whether your prescription is included. Also, the federal government is directing Medicare Part D (prescription drug plans) and Medicare Advantage plans to allow early refills, too, but you should check with your plan for more details.
Q: Could I get a surprise bill if I need testing or treatment for coronavirus?
You should not get a surprise bill for testing for coronavirus. All health plans are covering testing without coinsurance, copays or deductibles when you see an in-network primary care provider or are tested at an in-network facility. If you are treated at an emergency room, you also should not receive a surprise bill from an out-of-network provider. If you have questions about your coverage, contact your health plan. Contact us if you need additional help or if you believe you have received a surprise bill.
Q: Will my health plan cover telemedicine for testing or treatment of coronavirus?
A: All health plans regulated by the state must cover telemedicine (www.leg.wa.gov) if an in-network provider offers it and the services are medically necessary. Kreidler ordered health insurers to expand the methods for providing telehealth, including telephone and other web-based video tools during the nationwide public health emergency. Also, in an emergency proclamation from Gov. Jay Inslee, in-network providers who offer telehealth services must be paid the same as if they were providing the services in-person.
Contact your health plan to see if they offer telehealth through any of their providers.
Q: What should you do if you don’t have health insurance?
A: If you do not have health insurance, you should see if your income qualifies you for free coverage (www.hca.wa.gov). You can enroll in Medicaid year-round through Washington’s Health Benefit Exchange (www.wahealthplanfinder.org). If you need an individual health plan, you have until April 8 to sign up for a health plan by calling the exchange at 1-855-923-4633. After April 8, you must qualify for a special enrollment to get covered.
If you believe you need to be tested for coronavirus, you should contact a local medical provider first. Find a local community clinic (www.wacommunityhealth.org) near you.
Holly Hahn with the Hospitality Industry Health Insurance Trust (H.I.H.I.T.) also supported this content.