Does my health insurance cover testing?
Governor Abbott and the Texas Department of Insurance (TDI) have asked health insurers to waive certain costs and requirements relating to testing and treatment for COVID-19.
The following health insurers and Health Maintenance Organizations are currently waiving cost-sharing (copayments, deductibles, and coinsurance) for medically-necessary testing of COVID-19. Visit their websites for more information.
- Aetna (CVS)
- American National
- Blue Cross and Blue Shield of Texas
- CHRISTUS Health Plan
- Cigna Health of Texas, Inc.
- Clover Insurance
- Community Health Choice, Inc.
- Golden Rule Insurance (UHC)
- Humana Health Plan of Texas, Inc.
- Molina Healthcare Insurance Company of Texas
- Nippon Life Insurance Company of America
- Oscar Insurance Company
- Scott & White Health Plan
- Sendero Health Plans
- Superior Health Plan (Centene)
- United Healthcare Insurance Company
- USAA Life Insurance Company
- Wellfleet Insurance Company
Waived copays for COVID-19 testing may only be for in-network care. If your doctor wants you to be tested, you can use your health plan directory to find hospitals and labs in your area that are part of your health plan’s network.
How do I know if these protections apply to my health plan?
These waived costs apply to you if you are covered by a state regulated insurance plan. If you have a state regulated health plan, your insurance ID card will display “TDI” for Texas Department of Insurance or “DOI” for Department of Insurance.
The Employees Retirement System of Texas (ERS), the Teacher Retirement System of Texas (TRS), The Texas A&M University System, and The University of Texas System have also been asked to provide the same benefits to employees and retirees covered by their PPO and HMO plans.
What does Medicare cover?
- Medicare covers lab tests for COVID-19 with no out-of-pocket costs.
- Medicare covers all medically necessary hospitalizations.
- There is currently no vaccine for COVID-19, but if one becomes available, it will be covered by all Medicare Prescription Drug Plans (Part D).
- Medicare Advantage Plans are allowed to waive cost-sharing for COVID-19 lab tests.
- Check with your Medicare Advantage Plan about your coverage and costs.
- Medicare covers telehealth and related services so you can connect with your doctor by phone or video.
To learn more about Medicare and COVID-19, visit their website.
Can someone without insurance get tested?
You can call 211 to be directed to no-cost or low-cost providers in your area. Your health care provider may also contact a local public health authority to decide if testing at a public or private lab is appropriate.
If you don’t have a doctor or health insurance but are worried that you might have COVID-19, check your local health authority’s website to see if there is a hotline that you can call for help.
Can I go to a drive-thru testing site?
If you believe you should be tested for COVID-19, visit the Texas Health Trace website to use the COVID-19 self checker and consult your doctor. For more information about drive-thru testing locations, visit DSHS’ website.
How can I make sure my testing and treatment for COVID-19 symptoms were billed correctly?
Many health plans waived out-of-pocket costs for COVID-19 testing and treatment. If you received a bill with unexpected out-of-pocket costs for COVID-19-related treatment or testing, call your provider to see if they made a mistake. You can also check with your health plan or group benefits coordinator at work to make sure these services were correctly coded.
An incorrectly coded service could cost you more than you should pay, and you may appeal it. Contact TDI’s Consumer HelpLine at 1-800-252-3439 or visit their website for information on filing a complaint.
I lost my job due to COVID-19. What are my health insurance options?
Losing your job makes you eligible to apply for insurance coverage in the Affordable Care Act marketplace. You also have the right to continue your health coverage for a limited time after you lose your job.
- Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), workers and their families who lose their health benefits may choose to continue the coverage provided by their former employer.
- You must tell your employer that you want COBRA coverage within 60 days of becoming eligible for it by losing your job.
- COBRA continuation coverage is for a limited time and usually you must pay for it —sometimes at full cost— but it can help bridge the health insurance gap until you find other coverage.
- You can keep COBRA coverage for 12 months.
- To learn more about COBRA coverage, visit the U.S. Department of Labor’s website.
Certain types of retirement plans and health plans may provide you with more protections under the Employee Retirement Income Security Act (ERISA). To find out if these rights apply to your plan, you can visit the U.S. Department of Labor’s website, the Employee Benefits Security Administration (EBSA) website, or call 1-866-444-EBSA (3272).
You may also want to price and consider other health insurance options, such as a spouse’s plan, Medicaid, or the Health Insurance Marketplace.
Additionally, Texas law requires some group health plans to continue your coverage longer. Visit TDI’s website for more information, or contact them at 1-800-252-3439.
I need to see a doctor but I don’t want to go into the office. What are my options?
Most health plans offer telehealth options such as nurse line or virtual visits with no copay. Visit your insurer’s website to learn more about your options.
TDI filed an emergency rule requiring insurers to pay the same amount for telemedicine services as they do for in-person services, including for covered mental health services. The rule applies to in-network services for state-regulated health plans.
What about my prescriptions?
Some health plans allow patients to get a 90-day supply of medication. Ask your health plan if this is an option.
TDI has established emergency rules to allow Texans with state-regulated health plans to continue accessing their prescriptions with less need to leave their homes.
What can I do if my elective procedure/appointment is postponed due to COVID-19?
TDI is encouraging health insurers, HMOs, and utilization review agents to extend certain prior authorizations and referrals to help patients and health-care providers reschedule elective procedures without additional delays.
- Your health plan may be automatically extending prior authorizations for elective surgeries and procedures that were previously scheduled.
- Referrals may be extended for specialists, therapy, counseling services, and other medically necessary services that may have been disrupted.
- TDI has asked health plans that extend your prior authorizations or referrals to provide you with written notice of the updated authorizations.
- Check with your health plan or plan administrator to find out if this applies to a procedure or service that you need rescheduled.
To learn more, visit TDI’s website.
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