Testing & treatment information

Commercial:

Yes. Aetna is waiving member cost-sharing for diagnostic testing related to COVID-19 during the national public health emergency period, currently scheduled to end May 11, 2023.

Medicare/Medicaid:

Yes. 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 aligns with the Families First and CARES legislation and regulations requiring all health plans to provide coverage of COVID-19 testing without cost share. 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 COVID-19 serological (antibody) testing with no cost-sharing.

As of April 4, 2022, members with Medicare Part B can get up to eight over-the-counter COVID-19 tests each month while the COVID-19 public health emergency lasts. This includes those enrolled in a Medicare Advantage plan. The tests come at no extra cost. Members must get them from participating pharmacies and health care providers. They should check to see which ones are participating. Providers will bill Medicare. You can find a partial list of participating pharmacies at Medicare.gov. Members should take their red, white and blue Medicare card when they pick up their tests.

Aetna will cover, without cost share, diagnostic (molecular PCR or antigen) tests to determine the need for member treatment.¹ 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

Yes. 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.

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 and CARES Act legislation and regulations requiring all health plans to provide coverage of COVID-19 testing without cost share.

Members should not be charged for COVID-19 testing ordered by a provider acting within their authorized scope of care or administration of a COVID-19 vaccine. Providers can seek reimbursement for uninsured patients through the Health Resources & Services Administration (“HRSA”) for COVID-19 testing, treatment and vaccine administration. This information is available on the HRSA website.

Any test ordered by your physician is covered by your insurance plan.

Also, new federal guidelines allow members with private, employer-sponsored and student health commercial insurance to request reimbursement for over-the-counter COVID-19 diagnostic tests that are purchased on or after January 15, 2022 without physician’s orders¹. This mandate is in effect until the end of the federal public health emergency.

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.

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.

Tests must be FDA authorized in accordance with the requirements of the CARES Act.

Yes, Aetna will cover tests approved, cleared or authorized by the U.S. Food and Drug Administration. Please refer to the FDA and CDC websites for the most up-to-date information. A list of approved tests is available from the U.S. Food & Drug Administration.

At this time, covered tests are not subject to frequency limitations. Subject to applicable law, Aetna may deny tests that do not meet medical necessity criteria.

Based on federal guidelines, Aetna private, employer-sponsored and student health commercial insurance plans will cover up to eight over-the-counter (OTC) at-home COVID-19 tests per 30-day period for each person covered under your plan. This mandate is in effect until the end of the federal public health emergency. These guidelines do not apply to Medicare. Coverage is in effect, per the mandate until the end of the federal public health emergency currently scheduled to end May 11, 2023. Find more details on at-home COVID-19 tests.

As of April 4, 2022, members with Medicare Part B can get up to eight over-the-counter COVID-19 tests each month while the COVID-19 public health emergency lasts. This includes those enrolled in a Medicare Advantage plan. The tests come at no extra cost. Members must get them from participating pharmacies and health care providers. They should check to see which ones are participating. Providers will bill Medicare. You can find a partial list of participating pharmacies at Medicare.gov. Members should take their red, white and blue Medicare card when they pick up their tests.

For all Aetna-insured Commercial plans, Aetna waived member cost-sharing for inpatient admissions for treatment of COVID-19 or health complications associated with COVID-19 through February 28, 2021. This waiver may remain in place in states where mandated. Self-insured plan sponsors offered this waiver at their discretion.

Aetna will cover treatment of COVID-19 for our Medicare Advantage members. Please note that copays, deductibles and coinsurance will apply according to the member’s benefit plan.

The CDC recommends that anyone: who has 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.