Insurance coverage for COVID-19 testing

​ Most health insurance policies will cover the testing, office visit, and other medically necessary services related to COVID-19 without charging co-payments, co-insurance, or deductibles.

Several health insurance companies reached an agreement with the state to waive these fees. This means consumers with comprehensive individual and group health plans will not be charged co-payments, co-insurance, or deductibles related to COVID-19 for the following:

• COVID-19 laboratory testing administered consistent with guidelines issued by the United States Centers for Disease Control and Prevention.
• An in-network provider office visit or a visit to an in-network urgent care center to be tested for COVID-19.
• An emergency room visit to be tested for COVID-19.
• Immunization for COVID-19, once it becomes available.

There are several types of health insurance. Call your health insurance company to confirm coverage and locations for a COVID-19 test.

​ There are several types of health insurance plans available to Oregonians.

• Individual and group health plans –The agreement to waive co-payments, co-insurance, and deductibles for COVID-19 testing, office visit, and immunization (when available) applies to these types of insurance. These are comprehensive plans you get either through your employer or purchased through HealthCare.gov.
• Self-Insured – These plans are not subject to the cost-share agreement, but the state encourages employers that provide self-insured plans to provide this service to its employees. These are plans in which an employer assumes the financial risk of providing health care benefits to its employees. Oregonians who have a self-insured plan should check with their employer for more information.
• Medicare –The Centers for Medicare and Medicaid Services is allowing Medicare Advantage plans to waive cost sharing for COVID-19 tests. Visit CMS.gov for more information.
• High deductible health plans and health savings account (HSA) – The Internal Revenue Service advised that high-deductible health plans can pay for COVID-19 related testing and treatment, without jeopardizing their status. This also means that people with these plans may continue to contribute to a HSA. IRS.gov notice 2020-15 provides detailed information.
• Short-term health, mini-medical plan, or hospital indemnity plan – Check your coverage and contact your provider first. Typically, these plans do not offer comprehensive benefits and may not cover testing or immunizations when they are available.
• Health-sharing ministry – This health benefit is not insurance and does not have the same requirements of a fully-insured health insurance plan. Check with your provider first for coverage options.

A typical comprehensive health insurance plan covers medically necessary treatments. However, check with your insurance company to confirm how it is covered.

If you do not have comprehensive health plan, be sure to check with your insurance provider to understand how your coverage and cost sharing will apply.

Medicare Part B covers many preventive services, such as screenings, vaccines, and counseling.

If you meet the eligibility requirements and guidelines for a preventive service, you must be allowed to receive the service. This is true for Original Medicare and Medicare Advantage plans. However, your plan’s coverage rules may apply.

For more information on Medicare and the coronavirus, read the novel coronavirus Medicare fact sheet.

If you have questions or concerns about your Medicare insurance coverage, visit Medicare and coronavirus or call 1-800-Medicare (633-4227). Oregon Senior Health Insurance Benefits Assistance (SHIBA) also provides free information and assistance at 800-722-4134 (toll-free) or visit shiba.oregon.gov.​​​​​​​​​​​​​

​If you are admitted into a hospital for monitoring and observation, your co-payments, co-insurance, and deductibles will apply. Try to go to a hospital that is considered in-network by your health insurance plan. Many health plans do not provide coverage for out-of-network care.

In-network simply means that the hospital or provider has a contract with your insurance company. Contact your insurance company or visit its website for a list of in-network hospitals and providers.

Comprehensive health insurance plans typically cover emergency care regardless of the location, but it is always good to check your health insurance company’s network list of hospitals and providers, if possible.

Oregon’s balance billing law prohibits out-of-network providers working in an in-network facility from charging out-of-network rates to a patient. It also requires insurers to apply the in-network consumer cost-sharing amount to these services.