The COVID-19 pandemic started nearly two years ago. At the onset of the pandemic, public and private insurers quickly made changes to their coverage and payment policies in order to accommodate the need for testing, telehealth visits and later, for vaccines and booster shots. The extended nature of the pandemic has health insurance companies changing their plan benefits related to COVID-19 for 2022, and consumers need to be aware of the changes so that they don't encounter any unpleasant surprises in their billing.

Shift Away From Covering COVID-19 Test Fees

During the first months of the COVID-19 pandemic, getting a test was difficult. Healthcare providers didn't have enough swabs, cassettes or reagents. The United States government intervened to prioritize COVID-19 test supply production. Throughout 2020, insurance companies largely paid all the costs for a person who needed a COVID-19 test because of their job or health symptoms. In 2022, several insurers are ending their coverage for COVID-19 test fees. Security Health Plan in Marshfield, WI is one such company. They covered the expense of COVID-19 testing in full throughout 2021, but ended coverage for COVID-19 testing on January 1, 2022. According to a company spokeswoman, the test expenses will now be a part of the insurer's regular fee schedule in which patients will have a copay or coinsurance like they would for other tests, such as a flu test or strep test. The spokeswoman stated that this change aligns with federal recommendations and what other insurers are doing in 2022.

Change in When Testing Will Be Covered

Insurance companies are also changing healthcare benefits related to when a COVID-19 test will be covered. If a person has been exposed to COVID-19, their test will be covered regardless of whether or not they are vaccinated. Insurers may require the cost-sharing with copays and coinsurance. Similarly, a person with symptoms of COVID-19 can still get tested and have it covered by their health insurance plan. Again, co-pays or co-insurance may apply. These tests are medically necessary and are considered diagnostic tests.

When COVID-19 Tests Will Not Be Covered

If a person wants to travel and needs a negative PCR test to fly or to enter a foreign country as a tourist, insurers may no longer pay for that test. They deem these tests medically unnecessary. This trend is similar to what insurance companies do for other types of voluntary medical testing. For example, a person who needs a sports physical to participate in a sport may not necessarily have it covered by their insurance company, explained one spokesperson.

How Many Tests Are Medically Unnecessary?

One insurance company representative stated that out of 175,000 COVID-19 tests their company has paid for since the start of the pandemic, less than 50% were coded in a way that indicated the person had symptoms or an exposure to a case. This means that more than 50% of the tests were medically unnecessary. Those unnecessary tests add up, and insurance companies pass along the added costs to employers and members as higher premiums, copays and coinsurance for everyone else.

Changes in Testing for Return to Work or School

Until the end of 2021, most health insurance companies covered tests required by schools, colleges, universities and employers when a person had an exposure and needed to prove that they were not infected with COVID-19 in order to return to classes or the workplace. In 2022, many insurers have ended this coverage. This change is due to the Centers for Disease Control and Prevention's (CDC) updated guidance on quarantine and isolation from exposure or a positive test. Exposed people with no symptoms and who are vaccinated are no longer required to quarantine. Those who are COVID-19 positive now only need to isolate for five days before returning to work or school. Most employers, schools, colleges and universities have ended the requirement to provide a negative COVID-19 test to return, so insurers aren't paying for those tests.

Keeping Track of Healthcare Benefits for COVID-19

With CDC recommendations on COVID-19 quarantine, isolation and testing frequently changing, people will need to keep close track of their health insurance benefits for testing and treatment. The person's vaccination status may be a factor in whether or not the insurance company will cover testing in different situations. Vaccination status will also play a role in the duration of quarantine and isolation periods.