Major health insurers in Washington state waiving co-pays and costs for coronavirus patients

Apr. 4--Three of the state's largest health insurers have waived any out-of-pocket payments for medical treatments related to COVID-19, the disease caused by a new type of coronavirus spreading worldwide.

Kaiser Permanente Washington; Premera Blue Cross and its subsidiary, LifeWise Health Plan of Washington; and Regence Blue Shield made the moves this week after Washington state last month ordered insurers that operate on the state-run exchange to do the same.

State Insurance Commissioner Mike Kreidler issued an emergency order March 5 for health insurers that offer plans through the exchange to waive co-payments and deductibles for COVID-19-related doctor visits and testing for enrollees who meet criteria for testing. The order, which expires May 4, applies to individual market plans as well as small-group and large-group employer plans, which together cover about 1.2 million people insured through the Washington Health Benefit Exchange.

"I'm grateful to all our health insurers who are stepping up to take care of their enrollees during this incredibly challenging time," Kreidler said.

Regence will waive costs for COVID-19 patients through June 30, and Premera will do so through Oct. 1. Kaiser Permanente began waiving the out-of-pocket costs for COVID-19 patients Wednesday. All three insurance companies had already waived fees for COVID-19 testing.

"We have a special responsibility to our customers to be there for them during a time of tremendous fear and anxiety," Premera CEO Jeff Roe said in an emailed statement.

Companies that run self-funded plans through Premera can let the insurer know in the next couple of weeks whether they will extend the same cost forgiveness to employees, Premera spokesperson Dani Chung said.

The Centers for Medicare & Medicaid Services has also made some changes to reduce virus-related costs for COVID-19 patients on Medicare. Tests for the coronavirus ordered by a health-care provider who accepts Medicare are covered under Part B (outpatient services). This is the case if you are enrolled in traditional Medicare or Medicare Advantage. Co-pay and deductible amounts for the test have been waived, along with associated services such as physician visits or hospital observation.

Any needed outpatient services will be covered under Part B, and if you require hospitalization, it will be covered under the usual Medicare Part A rules. This includes a deductible of $1,408 for each stay, and daily co-payments if your stay exceeds 60 days. The most popular supplemental insurance policies used in traditional Medicare cover 100% of that, but 6 million enrollees have no supplemental insurance, according to the Kaiser Family Foundation, a nonprofit focused on national health-care issues that is unaffiliated with Kaiser Permanente.

For Medicare Advantage enrollees, the out-of-pocket costs for hospitalizations vary by plan and length of stay. Kaiser research found that for stays of five days or more, at least half of Advantage enrollees would pay more than the deductible paid by traditional Medicare enrollees without supplemental coverage.

On Friday, Kreidler warned people to be on the lookout for health-insurance scams related to the virus. The Office of the Insurance Commissioner (OIC) is working with state and federal agencies to identify scams and warn the public.

Since January, OIC's criminal investigation unit has received 667 insurance-fraud referrals and opened 29 criminal cases, passing along 11 cases to prosecutors, with six cases being adjudicated in court. There are currently 83 active cases being handled by the investigation unit.

Information from The New York Times was included in this report.

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