CMS issues FAQ on what ACA plan benefits cover with coronavirus

Coronavirus
CMS released an FAQ on Friday detailing what essential health benefits in ACA plans cover coronavirus treatment and testing. Image: Getty/ababil12

The Trump administration detailed what treatments and testing related to the coronavirus are covered by the Affordable Care Act’s essential health benefits, which each qualified health plan sold on the exchanges must cover.

The Centers for Medicare & Medicaid Services’ frequently-asked-questions document released Friday is the latest guidance released by the administration for providers and payers to handle the growing coronavirus outbreak.

“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,” said CMS Administrator Seema Verma in a statement.

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Key questions CMS attempts to answer include if the isolation and quarantine of coronavirus is an EHB, which all qualified health plans must include.

While medically necessary quarantine and isolation are covered under EHBs, the cost-sharing and “specific coverage limitations associated with these services may vary by plan,” the FAQ said. “For example, some plans may require prior authorization before these services are covered or may apply other limitations.”

The FAQ adds that an EHB generally includes coverage for the diagnosis and treatment of the virus, which has infected 1,215 people as of Thursday, according to the Centers for Disease Control and Prevention.

The FAQ comes amid questions over coverage of the coronavirus, especially with testing.

CDC Director Robert Redfield was pressed by congressional Democrats on whether he will exercise authority to cover testing for uninsured individuals. Insurers have agreed to also waive cost-sharing for coronavirus tests.

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