While the insurance companies in some states are no longer paying for COVID treatment without a co-pay for customers, Vermont still requires the companies pay for treatment and testing at no charge.
An article published in The Washington Post on Sept. 18 stated many insurers were restoring co-pays and deductibles that had been waived in 2020.
“If you’re fortunate enough to live in Vermont or New Mexico, for instance, state mandates require insurance companies to cover 100% of treatment. But most Americans with COVID are now exposed to the uncertainty, confusion and expense of business-as-usual medical billing and insurance practices — joining those with cancer, diabetes and other serious, costly illnesses,” the article states.
Michael Pieciak, commissioner of the Vermont Department of Financial Regulation, said that in any matter where the state has the ability to regulate, Vermont is still requiring that COVID-19 treatment be delivered without any out-of-pocket costs.
“If we didn’t do that and somebody hadn’t reached their deductible or hadn’t had any health care-related expenses that year, then they might be on the hook for whatever is the amount of their deductible,” he said.
Pieciak pointed out it is increasingly common for health care plans to have a high deductible.
“What we wanted to do was eliminate any financial burden or financial disincentive for Vermonters to go get treatment if they suspected, or if they did have a positive test of COVID-19. If you get it, get treated earlier,” he said. “Our theory, and I think it’s borne out in other situations, is that your course of care, it’s a better progression, your health is better and because they’re able to intervene earlier, it’s also less costly. It makes sense from a health policy perspective and we think it makes sense from a financial perspective as well.”
The coverage for tests in Vermont also includes other respiratory tests such as the flu.
Pieciak said that in March 2020, after Gov. Phil Scott declared a state of emergency due to the pandemic, the administration was able to set up free testing that was seen as a way to contain the spread of the virus. People who knew they had COVID could quarantine and share their contacts to track the virus.
But Pieciak said the Legislature was a “great partner” in establishing the requirement as of April 2020 that insurers cover the cost of treatment. The coverage policy for treatment without co-pay or deductibles extends to March but Pieciak said it would be possible to extend that deadline, if necessary.
The Washington Post article notes that insurers still are commonly covering the costs of testing and vaccinations.
Nissa James, health care director for the Department of Vermont Health Access, said Vermont Medicaid was able to quickly eliminate two of its few services that required co-payments, hospital outpatient services and pharmacy medicines, which eliminated the co-pay on medications that could be used to treat COVID.
“Together, these changes ensured that no co-payments would apply to COVID-19 testing, diagnosis or treatment services for Vermont Medicaid members,” she said.
James said one reason this was important was that state and federal health care officials recognized the importance of COVID testing in mitigating the spread of the virus. For some who rely on Vermont Medicaid, a co-payment for testing could be a barrier, James said.
“It was important to reassure Vermont Medicaid members that Vermont Medicaid is required to cover testing for the detection of SARS-CoV-2, which is the virus that causes COVID-19, and testing for the diagnosis of COVID-19 and this was inclusive of all in vitro diagnostic tests that had received emergency use authorization,” she said.
Devon Green, vice president of government relations for Vermont Association of Hospitals and Health Systems, said she considered it “really admirable” for Vermont to maintain a policy that COVID treatment be covered “especially when it’s not happening in other states.”
Green said the policy provides support to Vermont hospitals because when a patient is unable to pay, the financial burden typically falls on the hospital.
“This provides both the extra coverage that is helpful to hospitals especially at a time when resources are uncertain and also provides that incentive for people to get care, treat this sooner rather than put if off over anything like money concerns or affordability,” she said.
Pieciak said state officials believed the requirement was fair because insurance companies had saved money during the pandemic when hospitals couldn’t do non-essential procedures and, therefore, they had fewer expenses for covering patients who were putting off health care to comply with the hospital restrictions or because they were reluctant to leave home.
“We were one of the first states out of the gate on all of these issues. We thought it was really critical to support Vermonters financially so they weren’t burdened financially,” he said.