35
treatment is likely to be covered, the details on
Medicare deductibles and potential co-pays will
again depend on people’s Medicare plans or state-
specific Medicaid rules.
For those, like Askini, who are uninsured, the op-
tions are limited. Some hospitals offer charity-care
programs, and some states are making moves to
help residents access coverage. A growing number
of states have created “special enrollment periods”
to allow more people to sign up for Affordable Care
Act marketplace insurance plans midyear.
The U.S. Congress has been debating various
measures to deal with treatment costs, but none
of them appeared to be central to the $2 trillion
package lawmakers were negotiating on March 25
for imminent passage. Summaries of the bill
showed $100 billion in funds allotted for hospi-
tals, moves to boost access to telehealth services,
coverage of coronavirus- related vaccines with no
cost sharing, and an attempt to cut down on sur-
prise billing. But these would not address treat-
ment costs, and gaps remain.
Patient advocates suggest families keep an eye
out for cost savings where possible. For example,
they advise people who suspect they have COVID-
19 to call their doctor before going to the emergency
room. In many cases, doctors will advise that even
patients exhibiting symptoms of COVID-19, like
fever and cough, stay home to recover. In cases that
require hospitalization, patients should be pre-
pared to be charged a “facilities fee” upon walking
through the door. Askini’s first trip to the hospital in
Boston on Feb. 29, for example, included a $1,804
charge for her ER visit and an additional $3,841.07
for “hospital services.”
Patient advocates also advise watching out for
unexpected charges for imaging or lab tests, which
can be “out of network” even if the doctor is not.
Patients should attempt to get all information in
writing so that they can appeal bills if necessary,
says Caitlin Donovan of the National Patient Advo-
cate Foundation. And appealing is worth it. Provid-
ers and insurers often reverse or lower bills when
patients negotiate or go public.
These problems aren’t new. Before the pan-
demic, Americans faced high health care costs
compared with the rest of the world, and millions
already delayed medical care as a result. But with
COVID-19 sweeping the country, this old prob-
lem may exacerbate the new one: by attempting to
sidestep health care costs, many Americans may
avoid being tested or treated for the virus, making
the outbreak worse in the end.
“If you’re sick, you need fewer barriers,” Dono-
van says. “But also, it doesn’t help society to have
people still crawling around going to their job and
getting other people sick.” —With reporting by
AlAnA AbrAmson/WAshington □A
N
A
L
Y
S
IS JENA STARKES IS REALISTIC about the challenges that
the COVID-19 pandemic presents to her family. The
45-year-old lives with her 81-year-old mother in Brooklyn,
and if either of them contracts the virus, they’re in trouble.
“If I get it and I give it to her, it is unlikely that she would
survive,” Starkes says. But if Starkes gets it and needs to
be hospitalized, she’d have a problem too. “What if I had
to be ventilated?” she says. “What if I had to pay $300 for
a test? I literally could not.”
Starkes owns her own web-design business, so she
neither receives employer-based insurance nor qualifies
for Medicaid. But she can’t afford to buy an individual
plan on the marketplace. So, like tens of millions of other
Americans, she’s facing down a global pandemic without
heath insurance.
On March 18, Congress passed the Families First
Coronavirus Response Act, which addresses a small slice
of this problem: the cost of finding out if you’ve got COVID-
19 in the first place. The law requires that all existing
insurers—Medicare, Medicaid, other government plans
and most private insurance—cover all COVID-19 testing
and testing- related services. That means no co-pays,
no deductibles, no co-insurance charges: free. That’s
supposed to be true even if you don’t have insurance, like
Starkes. The law provided $1 billion to reimburse medical
providers for uninsured patients’ testing, and it allows
states to choose to pay for uninsured residents’ COVID-19
testing through their Medicaid programs.
But patient advocates say it’s not that easy. There
are plenty of other ways the law fails to protect people,
even if you have insurance. The law says that insurers
must cover patient visits to doctors’ offices, urgent-care
centers, telehealth platforms or emergency rooms,
so long as the services “relate to the furnishing or
administration” of a COVID-19 test or “to the evaluation
of such individual for purposes of determining the need”
of a test. That means that if your visit does not result in a
COVID-19 test, you may end up with a bill. It also means
that if you get tested somewhere that is not in your
insurance plan’s network, you may end up with a bill. And
if you receive any treatment that is not directly related to
COVID-19 testing, you may, once again, end up paying.
“When your health plan has to cover [testing], that
just means the health plan has to cover what it would say
is a reasonable charge,” explains Karen Pollitz, a senior
fellow at the nonpartisan Kaiser Family Foundation.
“The difference between what your health plan thinks is
reasonable and what the provider bills you, that’s on you.”
The law also covers only testing starting the day it
was enacted, March 18. So if you got tested before then,
those services are not required to be covered.
That may seem unfair, but Starkes is unsurprised.
“That sucks. But that’s America,” she says.BY ABIGAIL ABRAMS
THE HIDDEN COST
OF FREE TESTING
WCOST.indd 35 3/25/20 6:11 PM