Federal law requires all private insurance plans to cover the entire cost associated with approved COVID-19 testing so long as the test is deemed medically appropriate. Additionally, the U.S. government pre-paid for COVID-19 vaccines and required COVID-19 vaccines be made available at no out-of-pocket costs regardless of whether the vaccine recipient is insured. However, while a handful of states required or created agreements with insurers to waive COVID-19 out-of-pocket treatment costs for their fully-insured plan enrollees, there is no federal mandate requiring insurers to do so.
Earlier in the pandemic, we found that the vast majority (88%) of people enrolled in fully-insured private health plans nonetheless would have had their out-of-pocket costs waived if they were hospitalized with COVID-19. At the time, health insurers were highly profitable due to lower-than-expected health care use, while hospitals and health care workers were overwhelmed with COVID-19 patients. Insurers may have also wanted to be sympathetic toward COVID-19 patients, and some may have also feared the possibility of a federal mandate to provide care free-of-charge to COVID-19 patients, so they voluntarily waived these costs for at least some period of time during the pandemic. Our subsequent analysis found that several of these insurers were starting to phase out COVID-19 cost-sharing waivers by November 2020.
In the last few months, the environment has shifted with safe and highly effective vaccines now widely available. In this brief, we once again review how many private insurers are continuing to waive patient cost sharing for COVID-19 treatment. We find that 72% of the two largest insurers in each state and DC (102 health plans) are no longer waiving these costs, and another 10% of plans are phasing out waivers by the end of October.