The Walz administration is pushing health insurers and employers to go further in waiving cost-sharing requirements for patients who need treatment for COVID-19.
In recent weeks, health insurers in Minnesota and across the country have committed to waiving out-of-pocket costs for people who need coronavirus testing and, in some cases, the office visit that’s connected with a test.
Now, state regulators are asking health plans to also waive cost-sharing for the treatments COVID patients might need — services that might otherwise generate more than $1,300 in out-of-pocket costs for each patient hospitalized with pneumonia.
“The departments believe that stronger measures more consistently applied across carriers are necessary to effectively combat the pandemic,” states a letter sent Friday by Health Commissioner Jan Malcolm and Commerce Commissioner Steve Kelley. “Simultaneous to this letter, the Walz administration is requesting legislative authority to require these measures of carriers in a manner consistent with the intent of this letter.”
The Minnesota Council of Health Plans, the trade group for the state’s nonprofit insurers, said in a statement to the Star Tribune that “treatment is a large unknown at this point, and most plans are not able to consider this further until more information is known.” The trade group pointed to a series of steps that carriers already have taken to enhance benefits for patients due to the coronavirus outbreak.
Eagan-based Blue Cross and Blue Shield of Minnesota, which is the largest insurer for state residents, said it would continue to evaluate and adapt its coverage policies as the pandemic evolves.
Many Blue Cross subscribers will not face copays, coinsurance or deductible costs for COVID-19 tests and related office visits, the insurers said. Blue Cross added that any needed care following a diagnosis of COVID-19 would be covered consistent with standard health plan benefits.
It’s with those standard benefits, however, that many people in employer-sponsored health plans face high deductibles.
A new report from the California-based Kaiser Family Foundation looked at potential COVID treatment costs for people under age 65 in employer-sponsored health plans and found average costs in 2018 ranged from $9,763 to $20,292. The study looked at hospital admissions to treat pneumonia for people under age 65 with varying degrees of complications and other health problems.
While health plans covered most of the costs, individual patients faced average out-of-pocket costs ranging from $1,300 to $1,464.
“That’s for people who have large-employer coverage, and those plans tend to be more generous than plans offered by smaller employers and people buying their own coverage,” said Cynthia Cox, a researcher with the foundation. “So, there are a lot of people who could face higher costs than that.”
In their letter, the Health and Commerce commissioners called on Minnesota insurers to make a variety of accommodations for patients given the coronavirus outbreak. Health plans said they have already adopted many of the changes voluntarily.
Insurers are being asked to provide a one-time refill on medications before the standard waiting period expires. The commissioners said that’s important for “social distancing,” where public health officials recommend limitations on mobility to slow the spread of disease.
“Carriers may take into consideration patient safety risks associated with early refills for certain drug classes, such as opioids, benzodiazepines and stimulants,” they wrote.
The commissioners asked that health plans prepare to adjust networks as needed as more patients seek care for COVID-19.
A growing number of health plans include strict network rules that subject patients to extra fees when they go outside the health plan’s primary network of doctors and hospitals. If there’s a rush of patients needing care due to the outbreak, patients could find their in-network doctors and hospitals lack capacity.
“Minnesota health plans play an important role in addressing a public health emergency by providing coverage through health plan benefits to Minnesota residents,” the commissioners wrote. “Crucial to an effective public health response is lowering barriers to access diagnosis and treatment of the disease.”
Insurers said they are already lowering financial barriers to care in the “fully insured” market, where small and midsize employers buy coverage. The insurers are providing broad access to telehealth and hotlines, the Minnesota Council of Health Plans says, while removing certain prior authorization requirements for diagnostic tests and covered services.
The changes don’t necessarily apply to self-insured employer health plans, which cover more than one-third of state residents. Those employers have the option of adopting the changes.
Self-insured health plans are beyond the scope of state regulation, but the letter from the Health and Commerce commissioners “strongly encourages self-insured plans to follow the guidance. Minnesota will be best positioned to address this public health crisis if health care coverage is provided consistently.”
One issue not addressed in the letter is the potential for “surprise bills,” where patients find they are on the hook for extra costs because some health care providers are in-network while others are out-of-network.
Some large health insurers have said they won’t charge higher cost-sharing for people who inadvertently go out-of-network, the foundation’s report noted. But that wouldn’t stop hospital and physician groups from billing patients for the extra costs, Cox said.
“We already know that people who get admitted to hospitals or go in through the emergency room often will face the risk of inadvertently going out-of-network,” Cox said. “You might have people who are otherwise pretty healthy encountering emergency rooms and hospitals for the first time and aren’t as familiar with the concept of provider networks and these things to look out for.”