Many states responded to the COVID-19 pandemic with actions intended to help residents obtain affordable or cost-free health care services. In most cases, states have required insurers to cover certain services or lift bureaucratic hurdles to coverage under temporary emergency orders. We’ve been tracking states’ actions for the duration of the pandemic; many of these emergency orders are about to expire. This means that most states’ COVID-19-related coverage mandates will expire. Some have already. Yet, whether or not we experience a “second wave” of the virus in the months ahead, SARS-CoV-2 is likely to be with us for a long time. States should thus consider whether to extend some mandates past the emergency period.
States’ Responses to COVID-19
Many state leaders recognized that lowering financial barriers to COVID-19-related services is critical to limiting the spread of the virus. New York was the first to mandate that insurers cover COVID-19 tests and waive cost-sharing. Now, federal law requires insurers to cover COVID-19 tests throughout the national emergency period; several state directives exceed this standard by requiring insurers to cover screening services not ordered or administered during the visit. Four states and Washington, D.C., also require insurers to cover COVID-19 treatment without cost-sharing.
States also have directed that insurers improve access to other health care services. For example, in 21 states and D.C. insurers must cover early refills of — or lift refill limits on — prescription drugs. Twenty-three states and D.C. also required insurers to expand coverage of telehealth services by, for example, requiring insurers to limit or eliminate enrollee cost-sharing, pay providers at parity with reimbursement for in-person visits, and expand the allowable devices or platforms that can be used.
What to Keep, What Not to Keep? Considerations for States
Testing and Treatment
There are compelling reasons for states to retain mandates that require insurers to cover and waive cost-sharing for COVID-19 testing and related services, such as a screening for symptoms or tests to rule out other diseases. While the federal mandate will expire when the national public health emergency does (currently July 25, 2020), there will likely be good reason to encourage people to get tested if they feel sick beyond that date. Ensuring the affordability and accessibility of COVID-19 tests is not just a near-term issue.
However, maintaining a benefit mandate that insurers cover and waive cost-sharing for COVID-19 treatment raises some questions. First, over the long term, is there a strong clinical or public health reason for coverage standards for COVID-19 to be different than coverage standards for other infectious diseases, such as HIV/AIDS, influenza, or hepatitis? Second, federal law requires states to defray the cost of benefit mandates that exceed the essential health benefits required by the Affordable Care Act. Should state taxpayers be required to pay for any increase in premiums because of a mandate to cover COVID-19 treatment? That said, until this virus is better contained or there is a vaccine, it will remain vital that people not fear seeking COVID-19-related services out of concern over cost. Delays in testing and treatment place too many at risk.
Early Refills for Prescription Drugs
It is common practice for insurers to limit the frequency of refills or the amount of medication a patient can obtain from the pharmacy to reduce overuse and curb spending. The states requiring insurers to loosen these restrictions did so to facilitate compliance with lockdown orders and instructions that individuals exposed to the coronavirus self-quarantine for at least 14 days. Although states’ emergency periods may officially end, the need to self-quarantine or increase social distancing if there is a second wave of the virus means it will remain important for insurers to waive some limits on prescription drug access.
Patients and providers have made a dramatic shift to telemedicine, with a projected 1 billion telemedicine transactions in 2020. Even after the pandemic fades, there are good reasons for states to maintain telemedicine coverage or reimbursement mandates. Telemedicine can provide essential access to a wide array of health care services. This is particularly important for people with mobility or transportation challenges, those who have trouble getting away from work, or people who live in underserved areas. However, states will need to weigh the risk that telemedicine’s convenience could drive the overuse of some health care services, potentially increasing premiums.
States’ COVID-19 emergency declarations are ending, as are the associated coverage mandates for private insurers. At the same time, the virus is likely to be with us for a long time; many experts predict a “second wave.” Before letting mandates lapse, states should consider maintaining those that keep the cost and logistical barriers to COVID-19 and other critical health services as low as possible.