COVID-19 test prices and payment policy – Peterson-KFF Health System Tracker

October 28, 2022

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note: this analysis was updated in April 2021.

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Two major legislative efforts passed at the start of the pandemic in March 2020: the Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief, and Financial Security (Cares) Act, required coverage of covid-19 testing – including the test itself, the related visit, and other services related to the test – at no cost share for people covered by most private health plans, medicare, and medicaid. Federal law also made resources available to fund free testing for the uninsured.

Reading: How much does insurance pay for covid testing

Since enactment, questions have been raised about the scope of the protections and when they apply. For example, some plans denied COVID-19 testing claims or applied cost-sharing for COVID-19 testing for asymptomatic individuals unless they knew or suspected they were exposed to COVID-19 and had a referral for testing from their provider. some denied claims of covid-19 testing unless directly ordered by a doctor.

Federal guidance released in early 2021 under the Biden administration clarified that insurers should cover testing without cost-sharing for people who are asymptomatic and without requiring medical exams. however, insurers are not required to cover COVID-19 testing without cost sharing if it is done as part of employee return-to-work programs or for public health surveillance purposes. Such limits mean that some patients with health coverage may nonetheless be billed for COVID-19 diagnostic tests and related services, and those bills can often be very different from patient to patient.

Outside the medicare program, there is no federal regulation of the price of covid-19 diagnostic tests or other related tests and visits. As for other health services, hospitals and laboratories can set their own rates for people with private insurance and without insurance. Private health insurers negotiate allowable charges with hospitals and providers that participate in their network. In the absence of a negotiated fee for out-of-network providers, insurers must pay the provider’s cash price, sometimes called list price, for COVID-19 tests and related services. The Care Act requires providers to post the cash price on their public website for use by insurers. these care act coverage and payment requirements apply for the duration of the public health emergency.

Negotiated rates (between payers and their in-network providers for covid-19 testing) are not always publicly available. however, the cares act’s price transparency rule offers a unique opportunity to examine what insurers pay for out-of-network care that should be covered. In this roundup, we present the results of our COVID-19 test price search, which we conducted from April 20-27, 2021. For each state, we searched for COVID-19 test prices posted on public websites of the two states. larger countries. Hospitals We were able to find COVID-19 diagnostic test prices for 93 of 102 hospitals, ranging from $20 to $1,419 per individual test, not including the price of a provider visit, facility fee, or sample collection. these services must be covered by insurance; however, patients may experience issues with billing or claim denials. some patients may be billed for test-related care by the hospital, provider, or insurer. We reviewed federal requirements and guidance on who may be charged for COVID-19 testing and related services. we then end with an extensive discussion of how uncertainty about what patients will be charged for health care services interacts with federal attempts at price transparency.

Medicare covers the tests with no cost-sharing for patients and reimburses providers between $36 and $143 per diagnostic test, depending on the type of test and how quickly it is processed. however, since there are no price regulations in the private market, the price insurers must pay network hospitals and providers under current law is their established and negotiated fee for service. The Care Act requires insurers to reimburse out-of-network providers for the cash price of COVID-19 tests posted on the provider’s website, though they can choose to negotiate that price on a claim-by-claim basis.

We searched the websites of the two largest hospitals in each state and the district of columbia to see if cash pricing for covid-19 diagnostic tests was available and how much those prices varied (see methods). We found pricing information for online COVID-19 diagnostic tests for 93 of the 102 hospital websites we examined. COVID-19 testing prices presented in this analysis do not include the price of related services, such as in-office or telemedicine COVID-19 testing, or for sample collection; however, some hospitals also post pricing information for these. Some covid diagnostic tests may be billed as a panel and also include detection of other viruses, such as influenza. Included in this analysis are COVID diagnostic tests including tests for influenza and respiratory syncytial virus.

We see a wide range of prices for covid-19 tests, even within the same hospital system. A given hospital may choose to publish different prices for a test for a variety of reasons, including the type of test, where it was performed, and which lab analyzes the medical sample.