Understanding Costs Associated with COVID-19 Testing Under the ACA

Introduction

The Affordable Care Act (ACA) and its amendments have played a significant role in shaping the accessibility and affordability of COVID-19 testing in the United States. This blog explores the complexities of insurance coverage for these tests, highlighting important considerations and protections for consumers.

What COVID-19 Tests are Covered Under the ACA?

The ACA requires most health insurance plans to cover FDA-approved or authorized COVID-19 tests without any cost-sharing, such as deductibles, copayments, or coinsurance. This coverage includes:

– Diagnostic tests: Used to determine if an individual currently has COVID-19.
– Screening tests: Used to detect COVID-19 in individuals who may not be showing symptoms.

Understanding Out-of-Network Charges

In some cases, you may receive a COVID-19 test from an out-of-network provider. Out-of-network providers are not contracted with your insurance company and can charge higher rates for their services.

Federal Protections for Out-of-Network COVID-19 Testing

The Coronavirus Aid, Relief, and Economic Security (CARES) Act and subsequent legislation prohibit out-of-network providers from balance billing individuals for COVID-19 testing. This means that you should not receive a bill from the provider for the difference between the amount your insurance pays and the provider’s charges.

Avoiding Surprise Bills

To protect yourself from surprise bills for out-of-network COVID-19 testing, it’s essential to:

– Check with your insurer: Before receiving a test, confirm that the provider is in-network or if out-of-network charges apply.
– Review your Explanation of Benefits (EOB): After receiving a test, carefully review your EOB to ensure that the provider is not attempting to balance bill you.
– Contact your insurer or the U.S. Department of Health and Human Services (HHS): If you receive a surprise bill, reach out to your insurer or the HHS for assistance.

Additional Considerations

– Travel-related testing: ACA coverage for COVID-19 testing does not apply to tests required for travel purposes. These tests may require payment out-of-pocket or through private insurance.
– Uninsured individuals: Individuals without health insurance can still access free COVID-19 testing through federal and local programs.
– Fraudulent testing: Beware of fraudulent or unscrupulous providers who may overcharge or provide inaccurate test results. Seek testing from reputable and licensed providers.

Conclusion

Understanding your ACA coverage for COVID-19 testing is crucial to avoiding unexpected costs. By following the guidelines outlined in this blog, you can ensure that you receive the necessary testing without facing financial burdens. Remember that federal protections are in place to protect consumers from surprise billing. If you have any questions or concerns, do not hesitate to reach out to your insurance provider or the HHS for guidance.