Many of the following changes were implemented in response to federal and state guidance and mandates during the COVID-19 public health emergency. These changes were made permanent by the Massachusetts Patients First Act effective January 1, 2021.
COVID-19 Testing and Treatment
The health plan covers services to diagnose or treat the 2019 novel coronavirus disease (COVID-19) when the services are furnished by a participating or non-participating provider. This coverage includes inpatient or outpatient services such as:
- Emergency medical care, including emergency ambulance transport.
- Hospital or other covered health care facility services.
- Cognitive rehabilitation services.
- Professional, diagnostic, and laboratory services.
- Medically necessary COVID-19 testing, including testing for asymptomatic members according to guidelines set by the Commonwealth of Massachusetts Secretary of the Executive Office of Health and Human Services.
Any deductible, copayment, and/or coinsurance, whichever applies, will be waived for diagnosis and treatment related to COVID-19 when the services are performed by a participating or non-participating provider.
These covered services also include covered drugs and supplies that are furnished by a covered pharmacy when prescription drug coverage is provided under the health plan.
If a benefit limit would normally apply to any of the covered services listed above, a benefit limit will not apply for covered services to diagnose or treat COVID-19.
Cost Estimates for Proposed Covered Services
Cost estimates provided to members by Blue Cross Blue Shield of Massachusetts will also include the member’s health care provider’s network status in addition to the estimate of the maximum allowed charge and the member’s cost share amount, if there is any, for the proposed covered service.
Telehealth services are available when the same in-person service would be covered by the health plan and the use of telehealth is appropriate. Health care providers will work with members to determine if a telehealth visit is medically appropriate for that member’s health care needs or if an in-person visit is required. For these covered services, members will not have to pay any more than the member would normally pay for an in-person office visit for the same covered services furnished by the covered health care provider. In some cases, the cost share amount that members pay may be less than the member would pay for an in-person office visit.
Blue Cross Blue Shield of Massachusetts (BCBSMA) is closely monitoring the new coronavirus (COVID-19) on behalf of our members and customers. The health and well-being of our members and customers is our top priority.
We remain committed to ensuring our members and customers have access to any care or information they need.
Effective March 6, 2020 BCBSMA will:
- Cover the full cost of diagnostic tests for COVID-19 for all fully insured members who meet CDC guidelines for testing. Members in fully insured plans will face no co-pay, co-insurance, or deductible for these tests. Self-funded employer groups will have the option of similarly waiving the cost share for these tests.
- Waive co-payments for medically necessary COVID-19 treatment at doctor’s offices, emergency rooms and urgent care centers. Any medically necessary treatment for coronavirus is covered under a member’s health plan within the United States or internationally.
- Remove any administrative barriers, such as prior authorizations and referrals, for medically appropriate care for COVID-19.
- Waive cost-sharing for members in plans with telehealth benefits. Telehealth offers convenience as well as the opportunity to avoid potential exposure to contagion. We will reach out to any employer customers without the benefit to ensure they know this option is available as well. We also will promote our 24/7 nurse hotline (888-247-2583), which is available free to all members and offers a safe and convenient clinical resource for minor ailments or questions.
- Increase access to prescription medications. Members will have access to early refills of their prescription maintenance medications. We will ensure formulary flexibility if there are shortages or access issues.
- Staff and promote a dedicated member help line (888-372-1970) for all COVID-19 related inquiries.
- Educate and inform the public about how to contain the spread of the virus.
- Our health news site, Coverage, produces timely, original news articles reporting what health consumers need to know about COVID-19.
- Impact to High-Deductible Health
- In a joint statement released today, in light of the current public health emergency, the IRS and Treasury announced that High-Deductible Health Plans (HDHPs) will still qualify as a HDHP and can cover Coronavirus (COVID-19) related testing and treatment costs, without any member cost share and before satisfying the deductible. This means that COVID-19 testing and treatment may be covered in full without jeopardizing the tax-favored treatment of Health Savings Accounts.
- An HDHP is a health plan that satisfies certain requirements for minimum deductibles and maximum out-of-pocket expenses. Generally, under Sec. 223(c)(2)(A), an HDHP may not provide benefits for any year until the minimum deductible for that year is satisfied. Today’s IRS announcement clears the path for waiving cost share for COVID-19 testing and treatment.
Reminder, the best measures to contain the spread of respiratory viruses are: frequently wash your hands with soap; cover your nose and mouth with your elbow while coughing or sneezing; stay home when you are sick; and get a flu shot. It does not protect against the coronavirus, but it will protect you against having to battle two potentially dangerous viruses at the same time. And more people protected against the flu means more clinicians can focus on treating coronavirus patients.
Please visit the BCBSMA coronavirus resource center for more information.