Testing & Treatment information

Aetna is waiving member cost-sharing for diagnostic testing related to COVID-19. The test can be done by any authorized testing facility. This member cost-sharing waiver applies to all Commercial, Medicare and Medicaid lines of business. The policy also aligns with new Families First legislation and regulations requiring all health plans to provide coverage of COVID-19 testing without cost share. The requirement also applies to self-insured plans. Per guidance from the Centers for Medicare & Medicaid Services (CMS), the Department of Labor and the Department of the Treasury, all Commercial, Medicaid and Medicare plans must cover certain serological (antibody) testing with no cost-sharing.

Aetna will cover, without cost share, diagnostic (molecular PCR or antigen) tests to determine the need for member treatment.¹ This applies to direct-to-consumer/home-based diagnostic or antigen tests. Aetna’s health plans generally do not cover a test performed at the direction of a member’s employer in order to obtain or maintain employment or to perform the member’s normal work functions or for return to school or recreational activities, except as required by applicable law.
 

Aetna will cover, without cost share, serological (antibody) tests that are ordered by a physician or authorized health care professional and are medically necessary. Aetna’s health plans do not cover serological (antibody) tests that are for purposes of: return to work or school or for general health surveillance or self-surveillance or self-diagnosis, except as required by applicable law. Refer to the CDC website for the most recent guidance on antibody testing.

This policy for diagnostic and antibody testing applies to Commercial, Medicare and Medicaid plans.²

Prior to COVID-19, testing for infectious diseases were included in the rate for surgical procedures and that policy will continue during the COVID-19 pandemic. Cost to the member will be determined by each individual health plan.

Yes. If the plan provides in and out of network coverage, then the cost-sharing waiver applies to testing performed or ordered by in-network or out-of-network providers. The policy aligns with Families First legislation and regulations requiring all health plans to provide coverage of COVID-19 testing without cost share. An order can often take place as part of being tested at a COVID-19 drive-through test site or purchasing a direct-to-consumer/home-based test.

An order from an authorized health care professional is required for covered COVID-19 tests for Aetna Commercial and Medicare plans. An order can often take place as part of being tested at a COVID-19 drive-through test site or purchasing a direct-to-consumer/home-based test.

In effort to expand testing capabilities, U.S. Department of Health & Human Services (DHS) authorized pharmacists to order and administer COVID-19 tests, including serology tests, that the FDA has authorized. Pharmacists, in partnership with other health care providers, are well positioned to aid COVID-19 testing expansion. An order can often take place as part of being tested at a COVID-19 drive-through test site or purchasing a direct-to-consumer/home-based test.

Routine testing for influenza, strep, and other respiratory infections without a COVID-19 test will be covered subject to applicable cost sharing under the member’s plan.

We cover, without member cost sharing, a same day office, emergency room, or other provider visit at which a COVID-19 test is ordered or administered. If as part of that visit the provider administers or orders a test for influenza, strep, or other respiratory infection, that additional testing will also be covered without member cost sharing. 

For Medicare and Commercial plans, the lab tests must be FDA authorized.

CVS Health is uniquely positioned to play a vital role in supporting local communities and the overall health care system in addressing the COVID-19 pandemic. Our ability to coordinate the availability of COVID-19 testing bolsters states’ efforts to manage the spread of the virus.

In March, CVS Health opened a pilot drive-through COVID-19 test site in a parking lot at a CVS Pharmacy store in Shrewsbury, MA. This pilot provided the company with a number of key learnings, which helped inform the company’s ability to improve on and maximize drive-through testing for consumers.

In April, CVS Health joined forces with the U. S. Department of Health and Human Services and state governments in Connecticut, Georgia, Massachusetts, Michigan and Rhode Island to help increase access to rapid COVID-19 testing at large-scale sites in publicly accessible areas. Each site operated seven days a week, providing results to patients on-site, through the end of June.

Since then, CVS Health has continued to expand access to COVID-19 testing, establishing testing sites at more than 1,800 CVS Pharmacy locations across the country.

For more information on test site locations in a specific state, please visit CVS.com.

Our pharmacies and MinuteClinics are uniquely positioned to help address the pandemic and protect people’s health. Building on the company’s comprehensive efforts to help slow the spread of the virus, we can bring safe and effective testing options closer to home and help increase access to testing options for even more individuals.  This allows us to continue to help slow the spread of the virus.

Testing will not be available at all CVS Pharmacy locations. Testing will not take place inside any retail locations, and CVS Pharmacy, HealthHUB and MinuteClinic will continue to serve customers and patients.

CVS Health currently has more than 1,800 drive -thru testing locations across the country offering COVID-19 testing. Through this effort we are hoping to provide access in areas of the country that need additional testing and are selecting CVS Pharmacy locations with this criteria in mind.

Yes, patients must register in advance at CVS.com to schedule an appointment. Patients will need to pre-register, provide their insurance information as appropriate and verify their eligibility for testing. Once they have registered, the patient will be provided with an appointment window for that same day or up to two days out.

Aetna will waive member cost-sharing for inpatient admissions for treatment of COVID-19 or health complications associated with COVID-19. This policy applies to all Aetna-insured commercial and Medicare Advantage plans and is effective immediately for any such admission through September 30, 2020. Self-insured plan sponsors offer this waiver at their discretion. 

Yes, Aetna will cover the cost for treatment of COVID-19 for our Medicare Advantage members in full in the provider office. We will also cover the cost of the hospital stay for all of our Medicare Advantage members admitted March 25, 2020 through September 30, 2020.

The CDC recommends that anyone with symptoms of COVID-19 who has been in close contact with a person known to have COVID-19, or who lives in or has recently traveled from an area with ongoing spread of COVID-19, should contact their health care provider and be tested.

Your doctor is in the best position to advise if testing is needed based on your symptoms. With tests in limited supply, providers are using a strict set of guidelines to determine when testing is appropriate.

If your symptoms change, contact your doctor again.

All claims received for Aetna-insured members going forward will be processed based on this new policy. If in-patient treatment was required for a member with a positive COVID-19 diagnosis prior to this announcement it will be processed in accordance with this new policy. In the event a claim has already been processed prior to this policy going into effect, members should contact Customer Service so the claim can be reprocessed accordingly.