The Centers for Medicare and Medicaid Services (CMS) is posting frequently asked questions (FAQs) on essential health benefits (EHB) coverage in response to the 2019 novel coronavirus (COVID-19) outbreak. This action is part of the broader, ongoing effort by the White House coronavirus task force to ensure that all Americans—particularly those at high-risk of complications from the COVID-19 virus—have access to the health benefits that can help keep them healthy while helping to contain the spread of this disease.
“Amid a serious outbreak like this one, Americans understandably crave the security and peace of mind that comes from understanding exactly how they will be covered,” says CMS Administrator Seema Verma. “Today’s guidance aims to give it to them. Working closely with states and issuers around the country, the Trump Administration will continue to provide pertinent information to strengthen the nation’s response and keep Americans informed.”
The FAQs detail existing federal rules governing health coverage provided through the individual and small group insurance markets that apply to the diagnosis and treatment of COVID-19. The FAQs clarify which COVID-related services, including testing, isolation/quarantine, and vaccination, are generally currently covered as EHBs in these markets. The purpose of the FAQs is to provide guidance to Americans enrolled in individual or small group market health plans, including HealthCare.gov consumers. As questions and issues continue to come to CMS, they will be addressed and added to these FAQs.
President Trump and Vice President Pence held a meeting with leading insurance companies and their industry associations in which many health insurance issuers announced they will be treating COVID-19 diagnostic tests as covered benefits and will be waiving cost-sharing that would otherwise apply to the tests. States are the primary regulators of health coverage and are continuing to work with issuers to ensure coverage of COVID-19 related services. Patients should contact their insurer to determine specific benefits and coverage policies, as these details may vary by state and by plan.
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