Testing and Health Insurance

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.

 *⃣ 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 these same benefits to employees and retirees covered by their PPO and HMO plans.

*⃣ To learn more about health insurance, visit The Basics, Shopping Guide, and Using Your Insurance sections of our website.

What does Medicare cover?

  • Medicare covers the 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. 

I lost my job due to COVID-19. What are my health insurance options?

If you participated in a qualifying retirement or health benefit plan from your employer, you have several important rights under the Employee Retirement Income Security Act (ERISA). To learn about these rights, visit the U.S. Department of Labor (DOL)’s website. You can also visit the Employee Benefits Security Administration (EBSA) website or call 1-866-444-EBSA (3272).

One of the most important options available to you after you lose your job is the right to choose to temporarily continue group health coverage. Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), many workers and their families who lose their health benefits may choose to continue group health benefits provided by their former employer. COBRA continuation coverage is for a limited time and usually you must pay for it, but it can help bridge the health insurance gap until you find other coverage. You may also want to price and consider other options, such as a spouse’s plan, Medicaid, or the Health Insurance Marketplace. To learn more about COBRA coverage, visit the DOL’s website.

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.

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 public health 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.

Healthcare Options

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, including covered mental health services, as they do for in-person 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. 

I had an elective procedure/appointment scheduled before COVID-19. What do I do now?

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 granted before March 22, 2020.
  • 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 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.

Auto Insurance Premiums

Due to COVID-19 some auto insurers have chosen to reduce, return, or discount premiums for consumers. The following personal auto insurance companies have announced they are reducing, returning, or discounting premiums for April and May. This list will be updated, but may be incomplete.
*⃣ Other insurance companies may be deferring payment, waiving late fees, or helping in other ways. You should contact your insurance company to learn more about your premium payment due to COVID-19.

Other Helpful Resources

Monitor the latest news from the Texas Department of State Health Services (DSHS).

Monitor the latest news from the CDC.

Feeling sick? Use the CDC’s COVID-19 Self Checker Tool before visiting a doctor or hospital.

Monitor the latest insurance industry updates from TDI.

Get information on disaster unemployment assistance from the Texas Workforce Commission (TWC).

Do you have a small business? Check out our resources page for business owners.

Texans who believe they’ve encountered price gouging should call 800-621-0508 or file a complaint online.