For Consumers

Health insurance and coronavirus (COVID-19) frequently asked questions

Will my insurance cover testing and treatment for COVID-19?

Yes. Most health insurance plans will cover testing and treatment for medically-necessary services related to COVID-19. Commissioner Kreidler has ordered all health plans his office regulates to waive copays and deductibles for people requiring testing (doh.wa.gov) for COVID-19. If you are concerned about whether or not you should be tested, read the guidance from the Department of Health and call your providers first. Copays and deductibles will still apply if you need treatment. 

The Centers for Disease Control and Prevention (CDC) is updating its recommendations (www.cdc.gov) for who should be tested. 

If you are a member of a health sharing ministry, your coverage may be limited. Check the language of your coverage to understand what’s covered and what’s excluded.

 

Is testing free? Is the patient exam free?

Commissioner Kreidler has ordered all health plans regulated by his office to cover testing for COVID-19 and the associated office visit and lab testing without copays or deductibles. His emergency order is in effect from March 5-May 4, 2020. State-regulated health plans include individual health plans, small employer health plans and some large employer plans. His order does not apply to employer plans that are self-funded, Medicaid, Medicare, federal employee health plans or health plans for members of the military or veterans. If you are unsure what type of health plan you have, contact your employer's HR department. We estimate there are 1.2 million people in state-regulated health plans in Washington state. 

Before you show up at your provider's office, make sure you have the symptoms necessary for testing (doh.wa.gov) (the criteria are changing as more tests become available) and contact your provider's office first. 

 

Will my health insurer waive my deductible since this has been declared an emergency?

Commissioner Kreidler has instructed all state-regulated health plans (PDF, 251KB) to waive deductibles and copays for people who need testing for COVID-19. State law gives him the authority (leg.wa.gov) to do so, once the governor has issued an emergency proclamation. The waiver only applies to the testing for COVID-19 and the provider visit to order the testing. This does not include tests and services for other conditions that may occur as part of the visit.

People who suspect they need testing should check with the Department of Health (doh.wa.gov) and contact their provider's office first. People who do not test positive for COVID-19 may still need to meet their deductibles and pay a copay. 

 

What if I have a high-deductible health plan with a health-savings account?

The co-pay and deductible waiver also applies to all high-deductible health plans with qualifying health savings accounts (HSAs), according to guidance from the IRS (PDF, 27KB).

 

What guidance are you giving to health insurers, if any?

We are telling all state-regulated health insurers (PDF, 251KB) to waive copays and deductibles for enrollees who need testing for coronavirus, COVID-19. This applies to the test itself and the provider visit. Also, we're telling health insurers to not require any prior approval for testing or treatment of COVID-19, to allow a one-time early refill for prescriptions, and allow enrollees to see out-of-network providers for testing and treatment with no additional costs, if the insurer doesn't have enough in-network providers to meet demand. 

 

Will my health plan allow me to refill my prescriptions early so I can have a 30-day supply on hand?

The commissioner has instructed health plans to allow for one-time early refill for most prescriptions. You should check with your health plan if you have questions about whether or not your prescription is included. Also, the federal government is directing Medicare Part D (prescription drug plans) and Medicare Advantage plans to allow early refills, too, but you should check with your plan for more details. 

 

Could I get a surprise bill if I need testing or treatment for coronavirus? 

You should not get a surprise bill for testing for coronavirus. All health plans are covering testing without copays or deductibles when you see an in-network primary care provider or are tested at an in-network facility. If you are treated at an emergency room, you also should not receive a surprise bill from an out-of-network provider. If you have questions about your coverage, contact your health plan. Contact us if you need additional help or if you believe you have received a surprise bill. 

 

Will my health plan cover telemedicine for testing or treatment of coronavirus? 

All health plans regulated by the state must cover telemedicine (www.leg.wa.gov) if an in-network provider offers it and the services are medically necessary. Also, the services and how they are delivered must meet federal and state standards for protecting your medical information. Contact your health plan to see if they offer telemedicine through any of their providers. 

 

What should you do if you don't have health insurance?

If you do not have health insurance, you should see if your income qualifies you for free coverage (www.hca.wa.gov). You can enroll in Medicaid year-round through Washington's Health Benefit Exchange (www.wahealthplanfinder.org). If you need an individual health plan, you have until April 8 to sign up for a health plan by calling the exchange at 1-855-923-4633. After April 8, you must qualify for a special enrollment to get covered.

If you believe you need to be tested for coronavirus, you should contact a local medical provider first. Find a local community clinic (www.wacommunityhealth.org) near you.