COVID-19: Out-of-Pocket Costs? For Labs, not so much.

I have to say, I am surprised by what I am seeing with the COVID-19 progression over the last few weeks. Max is generally pretty even-keeled about things like this. As such, I have been in the “hey, aren’t we overreacting a bit here?” camp for a while now. But the changes over the last few days have certainly gotten my full attention. For me, the global response over the last week has been both encouraging and a bit unsettling. Unsettling mostly because I feel like maybe I have been out of touch with the scope of this virus. I mean, if March Madness is getting canceled, we have some serious problems on our hands.

Trust me, I will be the first to say I have absolutely no idea where the pandemic will go from here. I will do my best to stay out of the way and look to the experts and industry leaders for direction.

But here at the intersection of healthcare and personal finance, I still want to help. So we will add to the efforts where we can. As usual, I am keeping my eye on out-of-pocket costs. I realize this is probably the last thing on anyone’s mind, but I like to stay ahead of the curve. Since I certainly don’t want to add to the concerns everyone already has about this virus, I am happy to report some good news. We need more good news these days. 

COVID-19 out-of-pocket costs in the flesh
Should we really be collecting dirty $20 co-pays during times like these?

COVID-19 Lab Test

Evidently, Centers for Medicare & Medicaid Services (CMS) created two new CPT codes to represent the lab test that tests for COVID-19. The new codes are U0001 and U0002. They released these codes way back on February 13th in preparation for the need to account for these lab tests. My understanding is the U0001 code represents the CDC test where the U0002 represents the non-CDC test, some of which are still in development. If you have been paying attention, you already know almost every single medical service has a code attached to it. For example, my free lipid panel lab test was code 80061.

Since these two codes are brand new, Medicare is still building these out in their system. They should be ready to accept them by 4/1/2020 for any tests provided after February 4th. These are likely the codes that will be billed to your medical insurance company should you need to have the test.

The COVID-19 lab test is a diagnostic test. A laboratory performs the test to confirm or determine if an individual has a disease.

As for the pricing for the test, I don’t have a good feel for that yet. Medicare labeled them both with an “L” indicator meaning they will be priced at the local level and not the national level. In other words, Medicare has not set the price yet.

You can see it here on the Medicare Fee Schedule.

COVID-19 Lab Screening Fee Schedule
A look at the COVID-19 lab test right next to some of the other tests we have already learned about.

But as far as out-of-pocket costs go, we are already starting to see a lot of payers providing guidance on how that will be handled. 

Medicare Out-of-Pocket Cost for COVID-19 Lab Test

I always like to start with traditional Medicare because they tend to set the tone on these things.

Medicare Part B covers medically necessary clinical diagnostic laboratory tests. Generally, these tests are not subject to the 20% Medicare coinsurance or the Part B deductible.

But there’s that ambiguous word, “generally”. So, I want to be clear here, Medicare has come out and specifically said they will waive out-of-pocket costs for the COVID-19 screening.

Medicare covers the lab tests for COVID-19. You pay no out-of-pocket costs.

CMS – Medicare & Coronavirus

So that’s great news for a large population of people who, from my understanding, are at a higher risk for complications from COVID-19. There are no out-of-pocket costs for a medically necessary screening. In my opinion, it is very likely most Medicare Advantage plans will follow suit if they haven’t already. Some of them already have.

What About COVID-19 Out-of-Pocket Costs for My Commercial Insurance?

As usual, Max cannot speak for all insurances. But I can say the insurance industry looks to be really stepping it up to do what they can to reduce COVID-19 out-of-pocket costs. Among other things, several large insurance companies have issued notices reporting they will also be waiving out-of-pocket costs for these COVID-19 lab tests. Many will also loosen up or completely eliminate authorization requirements to have the test. Here are some of the big players. As you read through the links, you will find this effort goes well beyond out-of-pocket costs.

  • Aetna will waive co-payments related to the virus. They specifically said they will waive all co-payments for diagnostic testing related to COVID-19. This includes member costs for all their commercial, Medicare Advantage, and Medicaid lines of business. They are also offering telemedicine for any reason free of co-payment to the patient for the next 90-days.
  • Blue Cross Blue Shield Association, representing 36 independent locally operated companies, said they would waive all cost-share for medically necessary diagnostic tests that are consistent with CDC guidance. 
  • Cigna said, “customers will have access to coronavirus (COVID-19) testing, as prescribed by health practitioners, and the company will waive all co-pays or cost-shares to help fight the rapid spread of the virus in the U.S. and for its globally mobile customers.”
  • Humana reported that they will waive out-of-pocket costs associated with testing for COVID-19 for patients who meet CDC guidelines at approved laboratory locations. They are also helping with telemedicine costs by waiving out-of-pocket costs for all urgent care needs for the next 90 days.
  • UnitedHealthcare is covering the cost of COVID-19 testing and will waive costs for COVID-19 testing provided at approved locations in accordance with U.S. Centers for Disease Control and Prevention (CDC) guidelines. This lab test coverage applies to all of their commercial insured members as well as Medicaid and Medicare members.

Thankfully, there are plenty of other commercial insurance plans following the lead of Medicare and these bigger payers.  

Final Thoughts

As unsettling as things are, the medical insurance industry appears to be responding to the COVID-19 pandemic. Medicare and several large insurance companies are waiving several forms of out-of-pocket costs. Some people would expect nothing less from health insurance companies. But putting policies and procedures in place to make this happen isn’t easy and insurance companies are really stepping up to the plate here. I know things will come up as no good deed goes unpunished, but I am happy with the direction this is going. I will try to keep this post updated, but the situation is very fluid and I cannot possibly predict what other services might fall under what I will call a “COVID-19 out-of-pocket waiver”.

For example, therapeutic services and inpatient hospitalizations related to the virus. I really don’t know how that will be handled by Medicare or other payers. I would guess these will hit the Medicare Part A deductible. CMS is still suggesting it will, but the government could end up making exceptions for these cases. As I said, the situation is very fluid and changing by the hour. With all the high deductible plans, this could become a major problem at some point in the future.

Ultimately, I know out-of-pocket costs are probably an afterthought for most people right now. Keeping our families safe and informed is priority number one. But I am happy to see that when it comes time to foot the bill, insurance companies will likely pick up the tab for most of these lab tests. I am hopeful that a year from now we can look back and see that no one had to pay out-of-pocket for these tests.

As always, please stay healthy, wash your hands, and stay informed.

CDC INFORMATION Coronavirus Disease 2019 (COVID-19)

World Health Organization Coronavirus disease (COVID-19) outbreak

Has your insurance released any information on how they will handle out-of-pocket costs for COVID-19 services? If so, leave a link in the comments and I will add it to the body of this write-up.



2 Responses

  1. Dragon Guy says:

    Looks like United Healthcare has joined in the game as well.

    Although I hear a lot about these things don’t necessary apply to self insurance pans, which is what most employer sponsored plans are these days. Which just seems to add another layer of complexity and confusion to the whole situation!

    • Max OOP says:

      Thanks, I added this in. Great point about self-insured plans, but I am pretty optimistic those employers would have opted-in for covering this with no out-of-pocket.

      I think the bill (H.R. 6201, FAMILIES FIRST CORONAVIRUS RESPONSE ACT) that got passed last night also supports free testing, so once that is signed it becomes a moot point. It will force all payers to cover this test and Division G/Section 105 will provide reimbursement to providers for uninsured patients from the “National Disaster Medical System “. I am not too familiar with that source of funding, but at least providers won’t be on the hook.

      I took a very quick read of the bill this morning, looks pretty bulletproof for coverage of the lab test, and even has protections built in for ancillary services that might result during the testing like ER or physician charges.

      Outlined in Division G

      “Section 101. Coverage of Testing for COVID-19. This section requires private health plans to
      provide coverage for COVID-19 diagnostic testing, including the cost of a provider, urgent care
      center and emergency room visits in order to receive testing. Coverage must be provided at no
      cost to the consumer. ”


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