CMS Issues FAQs on Catastrophic Health Coverage for COVID-19

King & Spalding

On March 18, 2020, CMS issued Frequently Asked Questions (FAQs) to clarify that the diagnosis and treatment of Coronavirus Disease 2019 (COVID-19) is covered by catastrophic health plans. CMS also confirms that the agency will not take any action against a catastrophic plan that amends its terms to change or waive cost-sharing requirements for COVID-19 related services.

Catastrophic health plans, which offer coverage in times of emergencies as well as for preventive care, must cover essential health benefits (EHB) under Section 1302 of the Affordable Care Act. Exact coverage details, preauthorization requirements and cost-sharing requirements may vary by plan. However, catastrophic plan coverage of EHBs are subject to certain limitations, including deductible requirements.

CMS’s FAQs clarify that EHB coverage includes coverage for the diagnosis and treatment of COVID-19. CMS further confirms that in light of the ongoing COVID-19 crisis, the agency will not take enforcement action against any health issuer that amends its catastrophic plans to provide coverage for services associated with the diagnosis or treatment of COVID-19 before an enrollee meets their catastrophic plan deductible. The agency also expressly encourages states to take a similar approach to permit catastrophic plans to waive cost-sharing limitations to coverage.

The CMS press release announcing the FAQs is available here. The FAQs are available here.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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