As coronavirus cases multiply in the United States, one concern Americans have is what they can expect to pay if they seek treatment.
Speaking from the , President Donald Trump suggested that people with health insurance shouldn鈥檛 have to worry about that.
鈥淓arlier this week, I met with the leaders of the health insurance industry who have agreed to waive all copayments for coronavirus treatments, extend insurance coverage to these treatments, and to prevent surprise medical billing,鈥 Trump said March 11.
We found that鈥檚 an exaggeration, at best.
We contacted spokespeople for the White House and the Department of Health and Human Services seeking clarification and did not get a response. But March 12 on CNN, Vice President Mike Pence said insurers have agreed to waive copays for coronavirus tests 鈥 not treatment.
The of Trump鈥檚 March 10 meeting with the insurance industry shows that, in fact, company leaders agreed to waive all copayments for coronavirus tests 鈥 not treatments.
鈥淎ll the insurance companies here 鈥 either today or before today 鈥 have agreed to waive all copays on coronavirus testing and extend coverage for coronavirus treatment in all of their benefit plans,鈥 Pence said.
That鈥檚 a big distinction.
An Incomplete Picture
For one thing, a shortage in diagnostic supplies means that . You have to present symptoms to qualify. If you don鈥檛 receive a test but do get screened, that qualifies as a doctor鈥檚 visit 鈥 not a coronavirus test. That qualifies for a copay.
鈥淚t鈥檚 not even waiving copays or deductibles for services you need to get tests 鈥 emergency visits, doctors, etc.,鈥 noted Sabrina Corlette, a professor at Georgetown University’s Health Policy Institute. 鈥淚t鈥檚 鈥榳e鈥檒l waive copays for the tests,鈥 which is the lab service.鈥
Health plans will cover treatment for coronavirus, including hospital stays, said Kristine Grow, a spokesperson for America鈥檚 Health Insurance Plans, a major lobbying group. But they won鈥檛 necessarily waive copays or cost sharing for that treatment.
And there are other nuances to getting treatment that might entail higher cost sharing. If a coronavirus diagnosis ultimately means a patient needs to be put in a private room, or some other form of isolation, that service costs more. And even if it鈥檚 covered, patients could end up paying part of the price out-of-pocket, Corlette said.
For surprise medical bills, it鈥檚 trickier. Insurance plans can do a lot, such as waiving in-network cost sharing when someone gets treatment for the coronavirus, or agreeing to change their benefit structure if a patient gets out-of-network care. But they don鈥檛 appear to have explicitly committed to do those things, Corlette said.
And the responsibility for surprise billing doesn鈥檛 fall just on insurance companies, said Zack Cooper, a health economist at Yale University, who studies surprise billing. Doctors and hospitals who are out-of-network are still able to balance-bill 鈥 that is, send patients a bill for whatever insurance has not paid.
Plus, big insurance companies are only part of the picture. About 61% of Americans with employer-sponsored health care have . Those plans, which are regulated by federal law,聽can opt out of the agreements around copayments.
With all those caveats, Corlette said, Trump鈥檚 assertion is 鈥渕isleading.鈥
What The Insurance Plans Said
The statements released by health insurance companies about waived costs are not as comprehensive as Trump indicated.
that it has 鈥渨aived all member cost sharing, including copays, coinsurance and deductibles, for COVID-19 diagnostic testing provided at approved locations in accordance with Centers for Disease Control and Prevention guidelines for all commercial insured, Medicaid and Medicare members. UnitedHealthcare is also supporting self-insured customers choosing to implement similar actions.鈥
Ethan Slavin, a spokesperson for Aetna, gave a similar response: He said the company will waive associated costs for members who get tested 鈥渁t any authorized location.鈥
Anthem March 6 that it would provide coverage of the coronavirus screening test at no out-of-pocket cost.
But again, those commitments are not comprehensive.
The statement by UnitedHealthcare doesn鈥檛 state it is waiving all cost sharing with respect to emergency treatment or post-stabilization, for example.
鈥淭he only place you can get tested in a lot of communities is still the hospital emergency room department, so that鈥檚 an emergency visit,鈥 said Sara Rosenbaum, a George Washington University professor of health law and policy.
While the White House meeting shows that at the moment health insurance companies have agreed to not charge copays for the tests, the rules could change rapidly for other costs, said Thomas Miller, an expert on health care policy at the conservative American Enterprise Institute.
鈥淟ooking over the horizon, we are going to be doing a lot of things differently,鈥 he said.
Joseph Antos, another health care expert at AEI, said that since the final bills for treatment are settled after the patient has been treated, patients who can鈥檛 cover in full what could be very high cost-sharing amounts have room for negotiation or special consideration.
鈥淢ost higher-income people with good insurance should be able to deal with those costs and should not expect additional discounts related to coronavirus,鈥 he said.
It鈥檚 also possible that Congress will decide to pass surprise-billing legislation given the circumstances.
Our Ruling
Trump said the health insurance industry has 鈥渁greed to waive all copayments for coronavirus treatments.鈥
This isn鈥檛 what those companies said. They agreed to waive copayments for coronavirus testing. That鈥檚 only one component, and it鈥檚 a far cry from waiving copayments for all treatment. And, despite what the president鈥檚 phrasing implies, Americans who seek a test and are turned away will not have their copayments waived, either.
Patients who seek testing for coronavirus, and even those who end up needing treatment, will likely still end up facing medical bills. The size and scope depends on their insurance plans and on which doctors they see.
The president鈥檚 statement is inaccurate. We rate it False.
