Frequently Asked Questions
Insurance Coverage and the Coronavirus (COVID-19)
The Pennsylvania Insurance Department (PID) developed this document to address insurance coverage questions about Coronavirus (COVID-19). Health insurers play a critical role in the public's ability to get health care services, which could help decrease the spread of the virus.
Coronaviruses are a large family of viruses that are common in people and many different species of animals, including cattle, cats, and bats. Coronaviruses can spread like a cold.
The new coronavirus is called "novel coronavirus (COVID-19)." It causes respiratory illness in people and can spread from person-to-person. This virus was first identified in Wuhan, China.
1. Where can I find more information about COVID-19?
The Pennsylvania Department of Health has a dedicated page for COVID-19 that provides daily updates. For the most up to date information, click here.
2. How do I know if my insurance will cover testing and treatment related to COVID-19?
All major medical, Affordable Care Act (ACA)-compliant plans, including those available through the federally facilitated marketplace (www.healthcare.gov), should cover medically appropriate COVID-19 diagnostic testing and associated treatment. Many insurers have already announced they will cover medically appropriate COVID-19 testing without any copays, deductibles, or cost-sharing for consumers and the department encourages patients to be aware of steps their insurance company is taking to increase access.
Medical Assistance covers medically appropriate laboratory testing for COVD-19 without any copayments. Associated treatment for COVID-19 is also covered, although there may be a nominal co-pay. If you cannot afford the co-pay at the time you receive the service, you will not be denied treatment although your provider may send you a bill for the copayment amount.
Excepted benefit policies, short-term, limited duration health insurance coverage, and/or health care sharing ministries can have significant limitations on coverage and may not provide the same level of access. If any consumer has a question about their insurance policy, we encourage them to contact their insurer and welcome inquiries to the Department's consumer hotline at (877) 881-6388.
2. Who pays for COVID-19 diagnostic testing if needed?
The federal Centers for Disease Control and Prevention (CDC) and the Pennsylvania Department of Health are currently performing tests without charge for COVID-19. However, commercial labs are in the process of implementing testing capabilities, and some have begun to perform tests. Hospitals and providers are expected to bill insurance companies for the fees associated with collecting the specimens, and labs are expected to bill for the costs associated with the actual testing, which then could be billed to the patient or to the patient's health insurance issuer. Many insurers have already announced they will cover medically appropriate COVID-19 testing without any copays, deductibles, or cost-sharing for consumers and the department encourages patients to be aware of steps their insurance company is taking to increase access.
Pennsylvanians receiving Medicaid coverage will not be expected to pay a co-pay for any testing relating to COVID-19.
3. What if I have health concerns that require emergency medical services?
In the event emergency medical services are requested or needed by individuals who have contracted COVID-19 or believe they may have come in contact with the virus, insurance carriers must cover emergency services for an emergency medical condition at in-network levels. Emergency services include transportation services, such as ambulance services, as well as inpatient and outpatient hospital services that are needed to evaluate or stabilize the patient.
Medical Assistance covers emergency services, although there may be a nominal co-pay for certain services. If you cannot afford the co-pay at the time you receive the service, you will not be denied treatment although your provider may send you a bill for the copayment amount.
4. Can my insurance carrier cancel or refuse to renew my insurance policy if I am diagnosed with COVID-19 or a preexisting respiratory illness?
No. The Pennsylvania Insurance Department prohibits individual or group accident and health insurance carriers from imposing any pre-existing condition exclusions, including in connection with COVID-19. Federal law and state regulations provide protections against preexisting condition exclusions in health insurance coverage, as well. However, preexisting condition consumer protections do not apply to short-term, limited-duration health insurance coverage or excepted benefit policies.
5. Is there a number to call if I have questions or need help with my health insurance?
Yes. The Pennsylvania Insurance Department has a team available to answer questions about insurance coverage and benefits at (877) 881-6388. You can also contact the PID if you receive an unexpected bill related to COVID-19, or other health care services.
6. Is there a number to call for Medicare Beneficiaries and Caregiver Inquiries?
Yes. If you have questions regarding Medicare beneficiaries and caregiver inquiries, please call CMS at (800) 548-9034.
7. Is there a number to call if you have Medical Assistance or CHIP coverage?
Yes. If you are enrolled in Medical Assistance and have questions regarding coverage, contact your managed care organization or the Fee for Service Recipient Service Center at 1-800-537-8862 .
If you are enrolled in CHIP and have questions regarding coverage please contact your CHIP insurance company or call 1-800-986-KIDS (5437).