COVID-19 treatments no longer fully waived by private insurers

Enrollment specialists like Kimberly Turner, Covering Wisconsin’s navigator regional lead for Southeast Wisconsin, can help you figure out what COVID-19 treatments are covered. (Photo provided by Covering Wisconsin)

Consumers could be in for a surprise when they see their coronavirus-related medical bills. Some insurers are no longer covering the full cost of COVID-19 treatment.

Early in the pandemic, cost-sharing, such as co-pays and payments for treatments not covered fully by insurance, were waived due to COVID-19. Now, with vaccination rates rising, private insurance companies are charging for services that were covered previously.

A report from the Kaiser Family Foundation found that nearly three quarters of the largest health plans in America were no longer waiving cost-sharing. This includes some insurers listed on the federal marketplace through the Affordable Care Act.

Medicaid, BadgerCare and Children’s Health Insurance Plans, or CHIP, should be unaffected.

Sadie Tuescher, owner of Wisconsin Health Insurance Advocate LLC, said testing continues to be fully covered by insurance companies because of a federal mandate. COVID-19 vaccines remain free of charge to everyone as well.

The changes mostly concern treatment. For instance, people may need to pay a co-pay for a doctor’s visit or hospital stays. Some treatments, including monoclonal antibodies, may not be covered because they are considered “experimental,” Tuescher said, pending approval from the Food and Drug Administration.

Courtney Harris, outreach and partner development manager for Covering Wisconsin, a nonprofit program connecting Wisconsin residents to health insurance, said the changes will affect individual plans differently.

Harris said people trying to reach their insurance provider should check their insurance card for contact information.

Justin Rivas, manager of the Milwaukee Enrollment Network and director of community health initiatives for the Milwaukee Health Care Partnership, said there are many factors that could affect someone’s coverage, including its quality tier – the percentage of insurer covers in a plan – and in- network health locations, or providers specific to an insurance plan.

Rivas said any time is a good time to contact insurance navigators, especially since there are many new options during the pandemic.


Where to find help:

To contact a navigator from Covering Wisconsin, call 414-400-9489. Navigators can help you reach your insurance provider, find out what’s covered on your plan and assist with appeals if you are billed incorrectly.

For a list of educational sheets with information on insurance, including how to apply and affordability, visit the Covering Wisconsin website.

Covering Wisconsin also hasa connector toolwhere people can find enrollment specialists in or around their ZIP code.

Open enrollment for Affordable Care Act health plans ended on Jan. 15, but you may still be able to enroll or change your plan during the Special Enrollment Period. This option is available for people who have had a qualifying change in life, including marriage, childbirth and a change in residence.

You might also qualify if you’ve recently lost your health insurance. You’ll need to apply within 60 days of the qualifying event to get coverage.

To find out if you qualify for Medicaid or CHIP coverage, visit the Healthcare.gov website.

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