Most Maine health plans no longer waive patient costs for COVID-19 treatment


Following a national trend, two of Maine’s largest health insurance providers – Anthem and Harvard Pilgrim – have stopped waiving patients’ out-of-pocket costs such as deductibles and copayments for COVID-19-related treatment, meaning that patients hospitalized for the illness will likely have to pay a lot more.

Only one major insurer of Mainers, Community Health Options, said it plans to continue waiving such patient costs through the end of the year, regardless of whether the policyholders being treated for COVID-19 are vaccinated or not.

According to provider guidance issued this month, Anthem Inc. stopped waiving patient cost-sharing for COVID-19 treatment at the end of January, while Harvard Pilgrim Health Care stopped only recently, on Aug. 7.

Kimberly Winn, senior communications specialist for Harvard Pilgrim, said it was one of the first health insurers in Maine and the region to announce waivers on cost-sharing for COVID-19 treatment.

“(But) vaccines are now easily accessible, free and are highly effective in preventing hospitalizations for those who contract COVID-19,” Winn said in a statement.

The elimination of waivers does not apply to Medicare patients in Maine, she said, as cost-sharing for those patients will remain waived until the end of the public health emergency.

Maine’s civil state of emergency ended June 30, but the U.S. Department of Health and Human Services has extended the national public health emergency until at least Oct. 17.

In Maine, Lewiston-based provider Community Health Options is the lone holdout still waiving deductibles and copays for all COVID-19-related treatment. Spokesperson Kathleen Hayden said the company will return to normal cost-sharing provisions for all its health plans in 2022.

Federal law requires all private insurance plans to cover the entire cost of “medically appropriate” COVID-19 testing, and the U.S. government prepaid for COVID-19 vaccines so the shot could be available at no cost regardless of whether the recipient has health insurance.

Some states, such as Massachusetts, Rhode Island and New Mexico, imposed requirements that insurance providers must waive out-of-pocket costs for COVID-19 treatment, but Maine is not among them, and there has been no such federal mandate.

Many insurance companies across the United States voluntarily waived out-of-pocket costs including copays and deductibles for COVID-19 treatment during the height of the pandemic, according to a report from the Kaiser Family Foundation and the Peterson Center on Healthcare. But with vaccines now widely available, many insurers are now phasing out those waivers.

An analysis from Kaiser and Peterson found that of the two largest health plans in each state and Washington, D.C., 72 percent are no longer waiving out-of-pocket costs for COVID-19 treatment. Almost half of those stopped doing so no later than April.

Of the roughly 28 percent of major U.S. insurers still waiving patient costs, 10 are set to end the policy by the end of October, and another 12 are set to do so by the end of the year.

The 102 plans reviewed represent 62 percent of all health insurance enrollment across the fully insured individual and group markets, and all of those plans had waived cost-sharing for COVID-19 treatment at some point during the pandemic, said the report, published last week on the two organizations’ Health Systems Tracker.

COVID-19 cases have been climbing in Maine because of the more highly communicable delta variant and a population that is still nearly 40 percent unvaccinated. On Thursday, Maine’s hospital leaders pleaded with the public to get immunized against the disease, saying hospitals around the state are now swelling with unvaccinated patients.

The state reported 415 new COVID-19 cases Saturday, the highest one-day total since May 3. On Friday, Maine health officials reported the highest number of critical care patients with COVID-19 in Maine since the height of the pandemic last January.

The number of COVID-19 patients in intensive care units jumped from 59 to 71 between Thursday and Friday. The only other time more than 70 people were in critical beds with COVID-19 in Maine occurred on Jan. 20, when there were also 71 people in critical care.


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