Pennsylvania’s Medicaid and CHIP programs, WellSpan Health and UPMC Health Plan have all announced COVID-19 testing and treatment policies, and Medicare has posted information about its coverage.
As LNP reported earlier, Gov. Tom Wolf previously announced that all major health insurers in the state have agreed to fully cover COVID-19 testing. However, that may not apply to people who work and have coverage through self-insured companies; they are encouraged to check with their employer.
Officials also noted that people with excepted benefit policies, short-term, limited duration health insurance coverage or health care sharing ministries "need to understand these plans can have significant limitations on coverage and may not provide the same level of access."
If a health care provider orders a COVID-19 test, original Medicare covers it with no out-of-pocket costs, federal regulators say. [Here's what AARP says about "What Medicare Covers When It Comes to Coronavirus."]
Original Medicare also covers phone or online “virtual check-ins” with its usual coinsurance and deductible, and says “If you're concerned about illness and are potentially contagious, this offers you an easy way to remain at home and avoid exposure to others.” If a vaccine becomes available, all Medicare Part D plans will cover it.
Medicare Advantage plans can waive cost-sharing for COVID-19 tests, administrators say, and members should check about their coverage and costs.
Medicaid and CHIP
Medicaid and CHIP programs will cover COVID-19 testing and treatment and have lifted some prior authorization requirements, according to a press release from Gov. Tom Wolf. I
t notes that testing is contingent on a health care practitioner determining it is needed, and that providers may not deny COVID-19 services that would normally require a copayment if the Medicaid or CHIP enrollee is unable to pay that co-payment.
Medicaid enrollment is year-round, and the administration says anyone currently uninsured should go to compass.state.pa.us to see if they qualify for Medicaid.
“For patients who have insurance or are covered by Medicare or Medicaid, WellSpan will collect the individual’s coverage information, but will not bill or collect any deductible, co-insurance, or any other payment for the screening, testing and treatment of COVID-19,” it said. “WellSpan will also not charge individuals who do not currently have health insurance for testing or treatment of COVID-19 coronavirus.”
“We recognize the need for prompt care for anyone impacted by this crisis and we want to remove any barriers people may face to receiving testing or appropriate care,” said Dr. R. Hal Baker, senior vice president of WellSpan Health and co-leader of the health system’s COVID-19 incident command response.
UPMC Health Plan
UPMC Health Plan announced policy changes in effect until June 15, including waiving all cost sharing for COVID-19 tests if members meet CDC testing guidelines and waiving cost sharing for telehealth.
The changes apply to people in its fully-insured commercial groups, individual ACA Marketplace plans, Medicare Advantage, and HealthChoices programs, “and self-insured employer group plans that opt into this coverage.”
It’s also reminding members of its MyHealth 24/7 Nurse Line at 1-866-918-1591 for guidance on non-emergency needs, and said it is expanding access to UPMC LifeSolutions, a telephonic service dedicated to helping individuals cope with challenging situations where “specially trained counselors are poised and ready to help our members.”