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The cost of COVID changes as insurers roll back coverage, with different rules for NH, Vt.

Valley News Staff Writer
Published: 9/23/2021 9:40:42 PM
Modified: 9/23/2021 9:40:47 PM

WEST LEBANON — COVID-19 patients in the Upper Valley may come away from the ordeal of treatment with very different medical bills, depending on where they get their health insurance.

As they have throughout the pandemic, Vermont rules continue to require private insurers to shield patients from costs associated with COVID-19 testing, treatment and vaccination. The goal, officials say, is to encourage people to get tested and seek treatment when necessary to help bring the virus under control.

Meanwhile this summer, as COVID-19 vaccines became more widely available, New Hampshire joined the majority of U.S. states in which the largest health plans have resumed cost-sharing, including deductibles and copays, for all COVID-19 care out of fears that continuing to waive them would drive up insurance premiums.

In fact, the Granite State never fully insulated the sickest patients from the costs of their care. People covered by New Hampshire-based private insurance plans have been on the hook for at least some of the cost of most COVID-19 hospitalizations and other treatments throughout the pandemic.

And Gov. Chris Sununu’s executive order requiring that health insurers in the Granite State cover all costs of COVID-19 testing and treatment delivered via telehealth by in-network providers was rescinded when the state of emergency he declared was lifted in June.

“We are now at a point in time where we understand that COVID-19 is an enduring situation and must be treated like any other medical condition,” Tyler Brannen, life and health director at the New Hampshire Insurance Department, said this week.

He pointed to a recent analysis by The Peterson Center on Healthcare and Kaiser Family Foundation that examined the two largest health plans in each state and found that 72% of them are no longer waiving out-of-pocket costs for COVID-19 treatment.

And 10 of the 29 insurers still waiving cost-sharing for COVID-19 treatment are set to end the policy by the end of October.

The analysis notes that about half of the plans examined stopped shielding patients from COVID medical bills when vaccines became available to most adults.

“Waiving cost-sharing indefinitely will impose upward pressure on New Hampshire’s health insurance premiums that will cause Granite Staters to incur more out-of-pocket expenses,” Brannen said.

Vermont is among the minority of states that continues to shield patients from out-of-pocket costs.

The Vermont Department of Financial Regulation this summer extended an emergency rule requiring that Vermont health insurers cover testing, treatment and COVID-19 vaccination without cost-sharing through March 2022.

“I’m glad that we renewed it,” said Michael Pieciak, the department’s commissioner. It “continues to be a very useful tool for us.”

The rule aims to remove financial barriers that might otherwise discourage people from getting timely treatment for COVID-19, he said. While the department considered rolling back the rule this summer when case counts and hospitalizations had decreased and vaccinations had risen, state officials decided to keep it in place.

Pieciak acknowledged that the requirement runs the risk of driving insurers to raise premiums.

“We thought it was good policy for the pandemic,” he said. “Even if there is a cost shift.”

Additionally, Pieciak said encouraging people to get tested and treated earlier would reduce costs in the long run.

Health insurers in Vermont saw larger profits than they were otherwise expecting in 2020, when people delayed elective and routine care during the pandemic, Pieciak said. He said that while many people have returned for deferred care in 2021, insurers still may see “some degree of benefit” due to people avoiding hospitals during the pandemic, and COVID-19 treatment is an “appropriate place to redirect those potential profits.”

Blue Cross and Blue Shield of Vermont, the state’s largest private insurer, did not increase premiums as a result of continuing not to require cost-sharing for COVID-19 testing, treatment and vaccines, according to Sara Teachout, Blue Cross’ director of government relations.

Vermont’s rule applies only to insurers based in Vermont, so Vermont residents covered through employer-sponsored plans in New Hampshire may find COVID-19 treatment is subject to copays and deductibles.

“The (New Hampshire Insurance Department) urges consumers to check with their insurer regarding any cost-sharing responsibilities they may bear before seeing their medical provider,” New Hampshire’s Brannen said.

In both states, COVID-19 testing and vaccines continue to be covered by private insurance companies without cost-sharing under federal rules.

But the extent to which testing costs are covered differs by state.

In New Hampshire, COVID-19 testing is covered without cost-sharing when “medically necessary,” such as when someone has been exposed to a confirmed case or when they have symptoms of the disease, said Andrew Demers, a spokesman for the New Hampshire Insurance Department. That does not include testing following a vacation, for example, he said.

Meanwhile, in Vermont, COVID-19 testing as well as other procedures such as flu testing that might be ordered as part of making a COVID-19 diagnosis are covered without cost-sharing by insurers in Vermont. If people do get a bill for COVID-19 testing in Vermont, Pieciak urged people to contact his department.

He said the department encourages people to get tested: “That’s how we slow the spread here.”

Pieciak said he was uncertain how long Vermont will continue to bar cost-sharing for COVID-19 treatment. He said he was hopeful that it might no longer be necessary once children under 12 become eligible for vaccination and once booster shots are available for the most vulnerable to serious illness and death, but the rule may need to be extended past the current expiration date of March 31.

The pandemic is in “a different phase,” he said. But it’s “premature to turn the page on it completely.”

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.




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