The changes in insurance coverage for COVID-19 testing will have the following effects:
Medicare beneficiaries enrolled in Part B will maintain coverage for laboratory-conducted COVID-19 tests without any cost sharing if prescribed by a healthcare provider.
The requirement for Medicare Advantage and private insurance companies to provide cost-free coverage for COVID-19 tests, including over-the-counter (OTC) and laboratory tests, will no longer be in effect. Some insurers might introduce limitations on the number of tests covered within a specific timeframe or mandate that tests be conducted by in-network providers. Consequently, individuals may be responsible for paying the full test price if it is not covered or may have to contribute copayments or meet deductibles, depending on their specific benefit plans. Certain patients may continue to have no financial obligations if their plans choose to maintain coverage without cost sharing.
State Medicaid programs must offer cost-free coverage for COVID-19 testing until the last day of the first calendar quarter commencing one year after the conclusion of the COVID-19 Public Health Emergency (PHE). With the COVID-19 PHE ending on May 11, 2023, this mandatory coverage will cease on September 30, 2024. Afterward, coverage may vary by state. Temporary Medicaid coverage options that previously provided free COVID-19 testing for uninsured patients will no longer be available.
Empire City Laboratories will handle claim submissions for insured patients directly to Medicare, Medicaid, and numerous insurance companies and managed care plans. However, it is important to note that patients may still be responsible for the entire cost of the test if it is not covered by their insurance, or they may have to pay a copayment or meet a deductible, depending on their specific benefit plan.
Many insurance companies now require patients to exhibit symptoms before covering the cost of testing. Therefore, including relevant ICD-10 codes associated with the symptoms can provide valuable information for coverage determinations and increase the chances of obtaining insurance coverage for the COVID-19 test.
There will be no impact on tests that were ordered prior to or on May 11, 2023. However, if testing is requested after May 11, 2023, and the patient is relying on insurance or a government program benefit to cover the cost of the COVID-19 test, the patient may be required to bear the full expense of the test, contribute a copayment, or meet a deductible, in line with the updated coverage policies implemented by the respective payors.
No, the order-to-result time for COVID-19 PCR testing will continue to be 1-3 business days.