Under the CMS rule, insurers must cover tests for asymptomatic patients


MedCity News

As the Food and Drug Administration approves more Covid-19 tests for asymptomatic patients, the Biden Administration is increasing the requirements for insurers to cover them. The Centers for Medicare and Medicaid Services issued guidance on Friday clarifying that health plans cannot withhold coverage for Covid-19 tests, even for patients with no symptoms or known exposure.

Under the Families First Coronavirus Response Act passed in March, insurers had to pay for Covid-19 testing with no cost sharing such as copays or deductibles or prior approval requirements. These requirements applied to all health insurers, including self-insured companies. However, insurers only had to bear the cost of testing “if this is medically appropriate for the individual,” as specified by a provider.

Now, health plans cannot use medical screening criteria to deny coverage to asymptomatic patients, CMS clarified.

“For example, insured people who want to make sure they are Covid-19 negative before visiting a family member could be tested without paying any co-payment,” the agency said in a press release.

However, the guidelines still do not require insurers to cover on-site testing or public health monitoring tests.

“This really applies to people looking for testing rather than large-scale on-site testing,” said Sara Collins, vice president of health insurance and access to the Commonwealth Fund.

Despite previous requests that insurers pay for Covid-19 testing, some patients were still faced with a bill. Patients tested in emergency rooms sometimes faced setup fees, even though insurers bear the costs associated with the test and providers do not bill patients for Covid-19-related care.

CMS also reminded healthcare providers that they can be reimbursed for giving Covid-19 vaccines to patients without insurance through the CARES Act Provider Aid Fund. As a preventive measure, vaccines must be covered under the Affordable Care Act, although this was repeated when the CARES Act was passed in March.

Photo credit: Jmsilva, Getty Images

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