COVID-19 Testing, Including Office Visits, Must Be Covered by Most Private Health Insurance, Says Wisconsin Insurance Commissioner
Madison, Wis. – Testing for COVID-19 must be covered by private health insurance, including cost-sharing like co-pays for office, urgent care, and emergency department visits, said Wisconsin Insurance Commissioner Mark Afable. The Wisconsin Office of the Commissioner of Insurance (OCI) issued a notice to insurers today aimed at clarifying federal requirements detailed in the Families First Coronavirus Response Act (FFCRA) and the Corona Virus Aid, Relief, and Economic Security Act (CARES).
“We need folks to know that testing for COVID-19 is available and can be accessed without any out-of-pocket costs," said Commissioner Afable. “Under federal law, most insurers cannot require cost-sharing like co-pays for office, urgent care, or emergency department visits. If you have symptoms of COVID-19 or have been exposed to someone with the disease, get tested."
Free community testing sites are also available for Wisconsinites. Access a full list of free testing sites
Individuals with private insurance who have been tested for COVID-19 and subsequently received a bill to cover associated costs like the office visit or handling costs should speak to their insurer about having those services covered without cost-sharing. Wisconsinites can also file a complaint with OCI
online complaint here or by calling 1-800-236-8517.
Any office visit during which a provider determines a COVID-19 test is needed and orders a test must also be covered by most insurers without cost-sharing.
Enacted in March 2020, the FFCRA and CARES Act together require many private insurance plans to cover COVID-19 testing and related services, including office visits (both in-person and telehealth), urgent care visits, and emergency department visits that are related to diagnostic testing for COVID-19. Both acts also collectively require those insurers to provide these services at no cost to those they insure. The CARES Act specifically expanded the range of COVID-19 diagnostic services that must be covered and requires any COVID-19 vaccine to be covered at no cost to consumers.
Federal requirements regarding testing include most health insurers. Specifically, these federal requirements apply to plans that are fully insured or self-funded plans, non-federal, governmental plans, and church plans. Individual and group health insurance plans offered through and outside of the federal Marketplace as well as grandfathered and transitional health plans must also meet these requirements.
More information can be found in the complete notice to insurers
here. Insurers with questions about the FFCRA and CARES Act are encouraged to consult this
Frequently Asked Questions resource from the Centers for Medicare and Medicaid Services (CMS) or the
federal guidance issued by CMS and the Departments of Labor and the Treasury.