On January 15, 2022, health insurers will be subject to new federal requirements to cover and waive cost-sharing for over-the-counter diagnostic tests for COVID-19 for the duration of the federal public health emergency. Past federal guidance required insurers to fully cover COVID-19 tests, but allowed them to require enrollees to first obtain a health professional’s determination that a test is medically necessary. The new requirements, published January 10, enable consumers to obtain the tests directly from pharmacies or online retailers without being seen by a health professional. With case rates surging and the costs of over-the-counter COVID-19 tests ranging from $14 to $34, this new benefit should provide significant financial relief to privately insured individuals. This expert perspective focuses on key provisions of the new coverage requirements as well as health equity considerations and implications for state insurance regulators.
Changes in Coverage: Managing the Loss of ESI in the Midst of COVID-19
On Thursday, May 14, State Health and Value Strategies, in partnership with technical experts from Manatt Health, Levitis Strategies, GMMB, and the Urban Institute hosted a webinar for states to help address the rapidly-evolving changes to the coverage environment. As the COVID-19 crisis evolves, it has become clear that rising unemployment will substantially reduce employer sponsored health insurance. Depending on how Congress responds, there are likely to be significant increases in Medicaid and Marketplace coverage, as well as more people uninsured. These coverage churns will leave states grappling to understand and implement timely and effective strategies to ensure individuals have access to, and enroll in coverage, that is most appropriate for their situation.
During the webinar, speakers discussed the models that have been published of where individuals are expected to gain coverage over the next 18 months, including data from a recent Urban Institute report, the impact on the Medicaid, individual, and employer-sponsored insurance markets, the role of special enrollment periods, and coordination with unemployment agencies. The webinar also highlighted communications opportunities and strategies for states to support enrollment.