The announcement on Friday, June 19, CMS announced that MA plans must continue not to charge cost sharing (including deductibles, copayments, and coinsurance) or apply prior authorization or other utilization management requirements for COVID-19 tests and testing-related services.
The Centers for Medicare & Medicaid Services (CMS) on Friday instructed Medicare Advantage plans and Medicare Administrative Contractors (MACs) to begin covering all COVID-19 tests required for nursing home residents under new testing guidelines.
In its letter to MA organizations, CMS provided clarity on coverage:
MAOs must not charge cost sharing (including deductibles, copayments, and coinsurance) or apply prior authorization or other utilization management requirements for:
- clinical laboratory tests for the detection of SARS-CoV-2 or the diagnosis of the virus that causes COVID-19 and the administration of such tests;
- specified COVID-19 testing-related services (as described in section 1833(cc)(1)) for which payment would be payable under a specified outpatient payment provision described in section 1833(cc)(2); and
- COVID-19 vaccines and the administration of such vaccines, as described in section 1861(s)(10)(A).
Insurers have instituted a variety of strategies to support patients and providers during the pandemic. America’s Health Insurance Plans is keeping track of how plans are ensuring Americans have access to the prevention, testing, and treatment needed to handle the public health emergency.
As health insurance providers across the country have taken action to remove cost barriers to care, AHP created a resource that catalogs some of the actions taken by insurers.