Questions abound about who pays what on COVID-19 coverage

Insurers have been offering reassurances that health plans will cover costs related to testing and treatment for COVID-19, but the detail on what that means is variable — and a good illustration of fragmentation in the U.S. health care system.

In Minnesota, health plans last week were telling consumers that tests and care for coronavirus illness would be covered according to an individual's health plan benefits, yet those benefits can include significant out-of-pocket costs in the form of co-payments and deductibles.

By the end of the week, some carriers were refining the message by saying cost-sharing will be waived for patients who need the test to confirm coronavirus, but those assurances don't necessarily extend to large multistate employers with "self-insured" health plans. Plus, cost-sharing waivers for one particular test don't encompass other types of testing and care patients would probably use.

"There are a lot of different ways that people get health insurance in this country, and so it's hard to make a rapid announcement that will actually put people's minds at ease," said Cynthia Cox, a researcher with the California-based Kaiser Family Foundation, a nonprofit group that tracks health insurance issues. "The coronavirus, in many ways, is exposing weaknesses in our health care system, from uninsured rates to high cost-sharing."

Public health officials are monitoring a growing global outbreak of a respiratory illness called coronavirus disease 2019 (COVID-19) that's caused by a new coronavirus that was first detected in Wuhan, China.

"We are prepared, at least for the next couple of weeks, for what we think would be initially maybe a few patients showing up with an exposure history that warrants testing in our urgent cares, and the possibility of a few patients showing up in our hospitals for care," said Dr. Mark Sannes, a senior medical director at HealthPartners, the Bloomington-based nonprofit operator of hospitals and clinics. Sannes said the health system is ready for the long-term, as well.

For now, patients who qualify for testing aren't being charged by the Minnesota Department of Health, which is the only source for the test. In the coming weeks, private companies are expected to start providing tests, and it's unclear how the diagnostic will be priced.

Connecticut-based Cigna announced Thursday that many of its health insurance customers would have access to coronavirus testing as prescribed by health care practitioners without any co-payments or cost-sharing requirements. The policy applies to Medicare Advantage plans, Medicaid coverage and individual insurance policies, as well as "fully insured" employer health plans (where insurers take the risk for medical costs). But the benefit is optional when Cigna is hired to administer self-insured plans, where employers are at risk for claims costs.

On Friday, Rhode Island-based CVS Health announced that its Aetna insurance division also would provide diagnostic testing as well as telemedicine visits related to COVID-19 with no co-pays. Again, self-insured employers could opt out.

It was a similar story at the health insurance division of HealthPartners, where chief administrative officer Jim Eppel explained that self-insured employers "hold the risk, and they make the decisions regarding benefits."

In 2017, more than one-third of Minnesotans were enrolled in self-insured health plans, according to state data.

HealthPartners said Friday that it would waive co-pays for the COVID-19 test but said it was too soon to say whether that might extend to telemedicine visits and other services.

"This is moving quickly," Eppel said. "Our main point as of today is simply: For those people who ask the question: 'If I have a COVID-19 test' — I'll call it a lab test related to COVID-19 — 'will I have to pay for it?' " The answer is: 'No.' We'll have to work through the rest of the dynamics."

Coverage is not in question for someone who is sick and needs treatment, Eppel said. But that's also where many patients would find that cost-sharing rules kick in, said Cox of the Kaiser Family Foundation.

Christopher Snowbeck • 612-673-4744

Twitter: @chrissnowbeck