Insurance is confusing. But it’s even more confusing when it changes frequently. And, thanks to COVID, there have been a LOT of changes in the last couple years.

The first big change was the requirement under the Families First Coronavirus Relief Act (FFCRA) that insurers cover the cost of COVID-19 testing. As explained by the Kaiser Family Foundation (KFF), “Starting on March 18 and lasting for the duration of the public health emergency, all forms of public and private insurance, including self-funded plans, must now cover FDA-approved COVID-19 tests and costs associated with diagnostic testing with no cost-sharing, as long as the test is deemed medically appropriate by an attending health care provider.” This requirement has led to millions of tests and contributed to saving a lot of lives. 

Shortly after the FFCRA testing requirement, many insurers voluntarily made the decision to also waive cost-sharing for COVID-related treatment. KFF points out the obvious, that “treatment costs may present a much bigger affordability concern for patients than testing,” so the announcement that carriers were waiving some or all of the costs was certainly welcome news. 

However, with vaccines readily available, many insurers have ended this cost-sharing waiver. In a recent article from the Dayton Daily News, we learn that, because people who are vaccinated are less likely to be hospitalized, many insurers have “started covering COVID-19 the same way they cover other hospital stays.” In other words, the claims will be subject to the plan deductible and coinsurance up to the out-of-pocket limit.

For employers, there are a ton of other COVID-related rule changes they need to be familiar with, including a number of changes to their already burdensome compliance requirements, but for employees and individuals, the cost-sharing change is the big one.

The Dayton Daily News piece cites a recent KFF report “that 72% of the two largest insurers in each state and Washington D.C. (102 health plans) no longer waive these costs, and another 10% of plans will phase out waivers by the end of October.”

We know that your clients are probably sick of hearing about COVID, and you’re probably sick of talking about it, so it’s less likely to be as big a topic of conversation during your insurance enrollment and renewal meetings this year as it was a year ago. Still, it is important to let clients know how their claims will be handled if they do contract the virus, so you may want to incorporate this into your list of talking points.

One great resource to help you learn how carriers are covering COVID is the AHIP website. America’s Health Insurance Plans has put together a dedicated page that explains how health insurers around the country have responded to COVID-19. 

Here’s the link to the AHIP resource:

Of course, most carriers also have a dedicated page on their websites for COVID-19 information, so be sure to take a look at those pages and talk with your carrier reps before the busy enrollment season begins this fall.