As coronavirus cases multiply in the United States, one concern Americans have is what they can expect to pay if they seek treatment.
Speaking from the White House, President Donald Trump suggested that people with health insurance shouldn’t have to worry about that.
“Earlier this week, I met with the leaders of the health insurance industry who have agreed to waive all copayments for coronavirus treatments, extend insurance coverage to these treatments, and to prevent surprise medical billing,” Trump said March 11.
We found that’s an exaggeration, at best.
We contacted spokespeople for the White House and the Department of Health and Human Services seeking clarification and did not get a response. But in an appearance March 12 on CNN, Vice President Mike Pence said insurers have agreed to waive copays for coronavirus tests — not treatment.
The telecast of Trump’s March 10 meeting with the insurance industry shows that, in fact, company leaders agreed to waive all copayments for coronavirus tests — not treatments.
“All the insurance companies here ― either today or before today — have agreed to waive all copays on coronavirus testing and extend coverage for coronavirus treatment in all of their benefit plans,” Pence said.
That’s a big distinction.
An Incomplete Picture
For one thing, a shortage in diagnostic supplies means that many people aren’t receiving tests. You have to present symptoms to qualify. If you don’t receive a test but do get screened, that qualifies as a doctor’s visit ― not a coronavirus test. That qualifies for a copay.
“It’s not even waiving copays or deductibles for services you need to get tests — emergency visits, doctors, etc.,” noted Sabrina Corlette, a professor at Georgetown University’s Health Policy Institute. “It’s ‘we’ll waive copays for the tests,’ which is the lab service.”
Health plans will cover treatment for coronavirus, including hospital stays, said Kristine Grow, a spokesperson for America’s Health Insurance Plans, a major lobbying group. But they won’t necessarily waive copays or cost sharing for that treatment.
And there are other nuances to getting treatment that might entail higher cost sharing. If a coronavirus diagnosis ultimately means a patient needs to be put in a private room, or some other form of isolation, that service costs more. And even if it’s covered, patients could end up paying part of the price out-of-pocket, Corlette said.
For surprise medical bills, it’s trickier. Insurance plans can do a lot, such as waiving in-network cost sharing when someone gets treatment for the coronavirus, or agreeing to change their benefit structure if a patient gets out-of-network care. But they don’t appear to have explicitly committed to do those things, Corlette said.
And the responsibility for surprise billing doesn’t fall just on insurance companies, said Zack Cooper, a health economist at Yale University, who studies surprise billing. Doctors and hospitals who are out-of-network are still able to balance-bill — that is, send patients a bill for whatever insurance has not paid.
Plus, big insurance companies are only part of the picture. About 61% of Americans with employer-sponsored health care have what is called a “self-insured” plan. Those plans, which are regulated by federal law, can opt out of the agreements around copayments.
With all those caveats, Corlette said, Trump’s assertion is “misleading.”
What The Insurance Plans Said
The statements released by health insurance companies about waived costs are not as comprehensive as Trump indicated.
UnitedHealthcare announced that it has “waived all member cost sharing, including copays, coinsurance and deductibles, for COVID-19 diagnostic testing provided at approved locations in accordance with Centers for Disease Control and Prevention guidelines for all commercial insured, Medicaid and Medicare members. UnitedHealthcare is also supporting self-insured customers choosing to implement similar actions.”
Ethan Slavin, a spokesperson for Aetna, gave a similar response: He said the company will waive associated costs for members who get tested “at any authorized location.”
Anthem announced March 6 that it would provide coverage of the coronavirus screening test at no out-of-pocket cost.
But again, those commitments are not comprehensive.
The statement by UnitedHealthcare doesn’t state it is waiving all cost sharing with respect to emergency treatment or post-stabilization, for example.
“The only place you can get tested in a lot of communities is still the hospital emergency room department, so that’s an emergency visit,” said Sara Rosenbaum, a George Washington University professor of health law and policy.
While the White House meeting shows that at the moment health insurance companies have agreed to not charge copays for the tests, the rules could change rapidly for other costs, said Thomas Miller, an expert on health care policy at the conservative American Enterprise Institute.
“Looking over the horizon, we are going to be doing a lot of things differently,” he said.
Joseph Antos, another health care expert at AEI, said that since the final bills for treatment are settled after the patient has been treated, patients who can’t cover in full what could be very high cost-sharing amounts have room for negotiation or special consideration.
“Most higher-income people with good insurance should be able to deal with those costs and should not expect additional discounts related to coronavirus,” he said.
It’s also possible that Congress will decide to pass surprise-billing legislation given the circumstances.
Trump said the health insurance industry has “agreed to waive all copayments for coronavirus treatments.”
This isn’t what those companies said. They agreed to waive copayments for coronavirus testing. That’s only one component, and it’s a far cry from waiving copayments for all treatment. And, despite what the president’s phrasing implies, Americans who seek a test and are turned away will not have their copayments waived, either.
Patients who seek testing for coronavirus, and even those who end up needing treatment, will likely still end up facing medical bills. The size and scope depends on their insurance plans and on which doctors they see.
The president’s statement is inaccurate. We rate it False.
By Shefali Luthra, Kaiser Health News and Amy Sherman, PolitiFact
Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.