Health Insurers Have To Cover COVID-19 Tests For Asymptomatic People, CMS Says

CMS issued a guidance Feb. 26 that requires group health plans to waive cost-sharing for COVID-19 testing even if a person doesn’t have symptoms or a suspected exposure, among other requirements.

Five things to know:

1. The guidance clarifies that private group health plans generally can’t use medical screening criteria to deny coverage for COVID-19 tests for asymptomatic members or those without a known exposure.

2. According to CMS, COVID-19 tests must be covered without cost-sharing, prior authorization or other medical management requirements. The guidance also states health plans must cover point-of-care COVID-19 tests and tests that are administered at a state or local testing site.

3. CMS’ guidance still permits health insurance plans to deny coverage for COVID-19 tests for public health surveillance or employment purposes if the individual is asymptomatic and doesn’t have a suspected exposure to COVID-19.

4. The guidance includes information for providers on how to get federal reimbursement for COVID-19 tests and for giving the COVID-19 vaccine to uninsured patients, such as through the Provider Relief Fund program. CMS also said the Health Resources and Services Administration’s Uninsured Program has already reimbursed providers $3 billion for testing and treating uninsured Americans.

5. The guidance, which was issued with the Department of Labor and the Department of the Treasury, follows an executive order signed by President Joe Biden on Jan. 21.

Find the full guidance here.


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