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CMS updates guidance on cost-sharing for COVID testing and vaccinations

The new policy requires insurers to cover testing even for individuals without symptoms or recent exposure.

The update, a response to a Jan. 21 executive order from President Biden, also addresses avenues for providers to seek federal reimbursement for providing vaccinations to uninsured individuals. (Photo: Shutterstock) 

Since the early days of the pandemic, insurers have committed (voluntarily and then by regulations) to waive cost-sharing requirements for COVID testing. However, there have still been questions about how often consumers could get tested or whether related services would be covered.

Related: The question of who pays for COVID testing is getting more complicated

The CMS last week issued new guidance to clarify some of its coverage requirement policies. Specifically, the updated guidance requires insurers to cover testing even if a patient is showing no symptoms of infection and prohibits them from requiring prior authorization for testing. For instance, individuals who want to get tested before going on a trip or visiting a vulnerable relative would be able to do so without having to pay out of pocket. Health insurers will still be able to refuse coverage if the test is for employment purposes and the individual has no suspected exposure or symptoms.

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Emily Payne

Emily Payne

Emily Payne is the current deputy editor for ALM's Business & Finance Markets and former managing editor for BenefitsPRO. A Wisconsin native, she has spent the past decade writing and editing for various athletic and fitness publications. She holds an English degree and Business certificate from the University of Wisconsin.

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