COVID-19 testing still an essential benefit

Coverage of associated services follows health plan rules

By Michael Pramik, Ohio Public Employees Retirement System

Dec. 2, 2020 – OPERS has been receiving questions from retirees regarding what is and what isn’t covered regarding the coronavirus, or COVID-19.

As a reminder, earlier this year the Trump Administration designated diagnostic testing for COVID-19 an essential health benefit under the Affordable Care Act. If you are enrolled in the Medical Mutual group plan offered by OPERS, we will be waiving your costs for the diagnostic testing associated with the coronavirus if the test is ordered by a medical provider.

Testing covers the cost of the test, as well as the cost of the provider visit, which could include a telehealth (telemedicine), urgent care or emergency room visit, to determine whether the COVID-19 testing is required, and the visit to administer the test.

Costs could include copays, deductibles and coinsurance. If you are diagnosed with COVID-19, all other associated services will be covered based on our current plan deductibles, copays and coinsurance. Your Medical Plan Description document provides more specific details about what is covered. If you have specific questions about your coverage please contact Medical Mutual at 877-520-6728.

If you’re a member of the OPERS Medicare Connector, Medicare Part B covers a test to see if you have coronavirus, as well as covering antibody tests. You’ll pay nothing for this test when you receive it from a laboratory, pharmacy, doctor or hospital, and when Medicare covers this test in your local area, the Medicare website states.

The website notes that Medicare Advantage Plans can’t charge copayments, deductibles, or coinsurance for clinical lab tests to detect or diagnose COVID-19.

For additional information, refer to your insurer.

Your health is important to us. Please take all precautionary measures to protect yourself and others during this time.

Michael Pramik

Michael Pramik is communication strategist for the Ohio Public Employees Retirement System and editor of the PERSpective blog. As an experienced business journalist, he clarifies complex pension policies and helps members make smart choices to secure their retirement.

Michael Pramik

Communication Strategist

  • The vaccine is (reportedly) free, but not the administration of it, i.e., giving the injection. Will the Medicare Supplement and Advantage plans cover that?

    • Ron,

      We found the following on the Centers for Disease Controls’ website:

      Vaccine doses purchased with U.S. taxpayer dollars will be given to the American people at no cost. However, vaccination providers will be able to charge an administration fee for giving the shot to someone.

      We recommend contacting your insurance provider.

    • Barbara,

      While we can’t speculate on something that might nor might not happen, we did have an expert in this area speak at the November Board of Trustees meeting. John Barkett, Senior Director of Policy Affairs for Willis Towers Watson, said the ACA case before the Supreme Court is not likely to disrupt the individual health care market.

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