Minnesota health insurers are offering more details about how they will handle coverage related to coronavirus testing and treatment, including more pledges that out-of-pocket costs will be waived for diagnostic tests.
The assurances mean that people in some employer plans will have coverage for testing that is like what has been promised by the federal government in the Medicare health insurance program.
Even with the assurances, cost questions remain for those who lack health insurance altogether, as well as for people with high-deductible health plans who might obtain health care services beyond just the test.
"The outbreak is certainly exposing gaps in both the kinds of coverage people have as well as the adequacy of the coverage that they have," said Sabrina Corlette, a research professor at Georgetown University. "Obviously, a huge issue is the fact that we have close to 30 million people who don't have any insurance coverage at all and, for that reason, may delay or forgo care."
Among those with private insurance coverage, the rise of health plan deductibles in recent years means that patients "could face pretty high cost-sharing when they seek care," Corlette added.
Public health officials are monitoring the growing global outbreak of the respiratory illness called coronavirus disease 2019 (COVID-19) that is caused by a new coronavirus first detected in Wuhan, China. The Minnesota Department of Health on Sunday reported the second case in Minnesota.
Public health labs have been the only facilities equipped to test for COVID-19 and governments have been waiving any costs. There is no specific treatment for coronavirus.
Minnetonka-based UnitedHealth Group said Monday that individuals who feel they might have been exposed to COVID-19 should immediately contact their primary-care provider — and should try calling ahead "to ensure safe and proper patient handling," the company that runs insurer UnitedHealthcare said in a statement.
America's Health Insurance Plans, the trade groups for carriers, said in a statement: "Health insurance providers cover any reasonable, medically necessary health care costs related to infectious diseases and medical conditions, including COVID-19. ... Please review the terms of your specific plan for coverage details."
It is within those coverage details that out-of-pocket costs can occur, as they do with treatment for other ailments.
Eagan-based Blue Cross and Blue Shield of Minnesota said that for those diagnosed with COVID-19, the insurer will waive all prior authorizations for diagnostic tests and covered services that are medically necessary and consistent with federal guidance.
Blue Cross, which is the largest health plan for Minnesotans, and UnitedHealthcare, which is the nation's largest health insurer, said they will waive cost-sharing for medically necessary diagnostic tests that are consistent with CDC guidance related to COVID-19. The decisions apply to "fully insured" health plans, which typically are offered by small and midsize employers, as well as health plans that the insurance companies operate in conjunction with the Medicare government program. Minnesota insurers HealthPartners, Medica and PreferredOne announced similar decisions.
The statements from the carriers don't fully address what will happen with testing coverage in "self-insured" health plans, which typically are offered by large employers that operate in multiple states. In 2017, about 38% of state residents in Minnesota were covered by self-insured health plans, according to state data.
Blue Cross said self-insured employers "will have the flexibility to apply the same no-cost structure." UnitedHealthcare said it was "supporting self-insured customers choosing to implement similar actions."
Insurance carriers make the decisions on benefits in fully insured plans because those employers have hired the insurance company to take the financial risk for the cost of employee medical claims. That contrasts with self-insured plans where employers are at-risk for claims costs, so carriers don't make decisions on covered services.
"Because there's so many different private and public payers, each of those will have their own policies," Lynn Blewett, a professor of health policy and management at the University of Minnesota. "There's no one system that coordinates the response." She added that about 240,000 people in Minnesota lacked health insurance in 2018.
Corlette of Georgetown said she expected most employers would cover the test as well as most related services. But depending on the employer plan, an assurance of coverage can come with a significant asterisk in the form of out-of-pocket costs.
"We've seen deductibles double in employer-based coverage," Corlette said. "The average deductible is now well north of $1,000. ... A lot of families just can't afford to shell out that much."
Minneapolis-based UCare doesn't work as an administrator for self-insured employers, so the health insurer has a simpler message to send about COVID-19 coverage. In a statement to the Star Tribune, UCare said: "We will waive all copays, coinsurance or deductibles for doctor-ordered COVID-19 tests meeting CDC guidelines for members in all of our plans, for the immediate future."
Blue Cross said it would help with "access to prescription medications by waiving early medication refill limits on 30-day prescription maintenance medications [consistent with member's benefit plan] and/or encouraging members to use 90-day mail order benefit." As part of its pledge on prior authorizations, Blue Cross said it would make dedicated clinical staff available to quickly answer questions.
UnitedHealth Group said an emotional-support help line operated by its Optum division is available for anyone experiencing anxiety or stress following the COVID-19 developments. Health care providers in Optum's growing division with clinics, urgent care centers and surgery facilities are ready to help COVID-19 patients, as well, the company said.
"Our top priority is the health and well-being of our members and patients — and the safety of those who deliver care," said Dr. Richard Migliori, the chief medical officer of UnitedHealth Group, in a statement. "While the situation is dynamic, we are committed to adapting and supporting those we serve."