Analysis examines gaps in coverage for COVID-19 evaluation under new federal law

A new Health Affairs Blog post analyzes the coverage requirements of the Families First Coronavirus Response Act, which was signed by President Trump on March 18. The post was written by Kao-Ping Chua, an assistant professor of pediatrics at U-M Medical School and a member of the Susan B. Meister Child Health Evaluation and Research Center, and Rena Conti, an associate professor at Questrom Boston University School of Business.

Under the new law, COVID-19 testing and the associated visit is fully covered for most people. However, the law does not require full coverage of a visit if COVID-19 testing does not occur and does not always require full coverage of the cost of testing to confirm or rule out other possible conditions such as influenza. As a result, many patients evaluated for COVID-19 exposure or symptoms consistent with COVID-19 may still be financially liable.
 
According to the authors, the circumstances under which COVID-19 evaluation is and is not free depends on the nature of the evaluation and the patient’s insurance type. 

“If a privately insured patient is tested for both the flu and COVID-19, the act requires full coverage of the visit and all testing. If that patient were publicly insured, the visit and COVID-19 test would be fully covered, but the flu test would not necessarily be fully covered. For both the privately and publicly insured, nothing would be covered if only a flu test is ordered," says Chua. 

Chua indicated that the act is designed for an overly simplistic world in which COVID-19 evaluation only involves COVID-19 testing. However, he says, “COVID-19 testing is not the same as COVID-19 evaluation. Evaluation could consist of no COVID-19 testing, COVID-19 testing only, testing for other conditions only, or testing for both COVID-19 and other conditions.” 

To increase detection of COVID-19 and slow the spread of the pandemic, Chua and Conti recommend that the financial protections of the Families First Coronavirus Act be universally expanded to eliminate patient financial liability for all forms of COVID-19 evaluation, regardless of whether COVID-19 testing is ordered.

READ THE FULL ARTICLE