Some Insurers End Broad Telehealth Cost-Sharing Waivers

by Leslie Small

When the coronavirus pandemic bore down on the U.S., health insurers not only moved to waive cost sharing for COVID-19 testing and treatment but also for telehealth visits of all varieties.

However, some major insurers have now ended their across-the-board cost-sharing waivers for non-coronavirus-related telehealth visits, putting certain members on the hook again for copays, coinsurance and/or deductibles if they opt for a virtual appointment.

"I think what they're trying to do is transition to a more sustainable model where the televisit is really an alternative to the in-person visit," says Dan Mendelson, founder of consulting firm Avalere Health. "They need some kind of a copay there to limit unnecessary utilization."

Yet Shawn Martin, CEO of the American Academy of Family Physicians, says that reinstituting financial barriers to virtual care may not be the wisest move as the pandemic continues and flu season ramps up. "By doing so, insurers are essentially incentivizing a higher risk modality, or they are incentivizing the most risky behavior, which is people don't seek care at all," Martin says.

CVS Health Corp.'s Aetna is one health insurer that has recalibrated its telehealth coverage policy. For its members in fully insured commercial plans, Aetna will continue waiving cost sharing for virtual and in-person coronavirus-related diagnosis and treatment through Dec. 31. But its previous policy of waiving fees for all types of telehealth visits ended as of June 4, says an Aetna spokesperson.

For members of Anthem's individual market or fully insured employer plans, waived cost sharing for non-coronavirus-related telehealth ended Sept. 30. Anthem’s Medicare members will continue to receive telehealth cost-sharing waivers for all types of visits through Dec. 31.

UnitedHealthcare says in a recent update on its website that for its individual and fully insured group health plan members, "there is $0 cost-share for non-COVID-19 related telehealth visits with network providers through Sept. 30, 2020. After that date, members will be responsible for any copay, coinsurance and deductible, according to their benefits plan."

Meanwhile, some health insurers — such as Highmark Inc. and Independence Blue Cross — are choosing to continue their broad telehealth cost-sharing waivers, according to a running list of pandemic-related insurer actions compiled by America's Health Insurance Plans.

From Health Plan Weekly