Hospitals may not charge patients with any type of insurance cost-sharing for COVID-19 testing and related services, according to the Families First Coronavirus Response Act.1

“This will certainly help patients,” says Helaine I. Fingold, JD, a healthcare attorney in the Baltimore office of Epstein Becker Green. For hospitals, it probably means more lost revenue. “Hospitals will have to decide whether to take a conservative or a more liberal approach,” Fingold observes.

The conservative approach is to forgo collecting cost-sharing for a broad range of patients, even those who do not seek treatment for COVID-19, but may need testing for the virus. The liberal approach would be to continue to collect cost-sharing for people who are not evaluated for a COVID-19 test.

“This will require a heightened investment in compliance and oversight,” Fingold says. An example of a gray area would be someone with a sore throat who undergoes a strep test, but also is evaluated as to whether a COVID-19 test is needed. “The process for making these distinctions must be clear and appropriately interpreted and applied,” Fingold stresses.

If high deductibles and copays are waived, it is not the health plan that bears the expense. “Those who eat the cost are the providers, which I’m not sure has been generally understood, and that’s a problem,” says Robert A. Berenson, MD, an institute senior fellow at the Urban Institute in Washington, DC.

Insurance companies are obligated to provide cost-sharing reductions to people whose household incomes are below 250% of the federal poverty line. This obligation was included in the Affordable Care Act (ACA), which stated that the federal government would cover these costs for insurers. “This makes sense, as it is not really the responsibility of private companies to provide subsidies to lower-income people, but rather the government,” says Jack A. Meyer, PhD, an independent healthcare consultant and former principal in the Washington, DC, office of Health Management Associates.

However, the Trump administration terminated the federal government’s commitment under the ACA to reimburse the insurers. “The insurers’ obligations to provide this cost-sharing reduction remains,” Meyer adds.

REFERENCE

  1. Congress.gov. H.R.6201 - Families First Coronavirus Response Act.