COVID-19 Treatment and Cost Share Guidance

Last update: October 12, 2020, 8:50 a.m. CDT

We want care providers to focus on delivering care and providing support to our members. UnitedHealthcare is implementing a cost share waiver for COVID-19-related care and treatment. Some services or facility exclusions may apply. Implementation for self-funded customers may vary. We will adjudicate benefits in accordance with the member’s health plan.

UnitedHealthcare is waiving member cost sharing for COVID-19 treatment. Treatment coverage may vary by health plan. Please review each section below for details. If a member receives treatment under a COVID-19 admission or diagnosis code, we will waive cost sharing (copays, coinsurance and deductibles) for the following: 

  • Office visits
  • Urgent care visits
  • Emergency department visits
  • Observation stays
  • Inpatient hospital episodes 
  • Acute inpatient rehab
  • Long-term acute care
  • Skilled nursing facilities

Treatment coverage may vary by health plan.  Please review each section below for details:

Medicare Advantage

  • Waiver of cost share is effective from Feb. 4, 2020 through Dec. 31, 2020.

Individual and Group Market fully insured health plans

  • Waiver of cost share is effective from Feb. 4, 2020 through Oct. 22, 2020 for in-network and out-of-network visits. 
  • From Oct. 23, 2020 through Dec. 31, 2020, UnitedHealthcare is waiving cost sharing for in-network visits only. 
  • Starting Oct. 23, 2020, out-of-network coverage will be determined by the member’s benefit plan.
  • Implementation for self-funded customers may vary.

Medicaid 

  • Waiver of cost share is subject to state regulations.

Medicare Advantage Plans and Individual and Group Market Fully Insured Health Plans

If a member receives treatment under a confirmed positive diagnosis of COVID-19 or has a COVID-19 admission between Feb. 4, 2020 and Dec. 31, 2020, providers will need to use code U07.1.

For Medicaid plans, state regulations apply. 

For a full list of associated codes and sequencing codes for COVID-19-related visits, see the ICD-10-CM Official Coding and Reporting Guidelines.

For members with a confirmed positive diagnosis of COVID-19, we will waive cost sharing (copays, coinsurance and deductibles) for all COVID-19-related care during inpatient treatment. Non-COVID-19-related services will be covered in accordance with the member’s benefit plan.

For members with a confirmed positive diagnosis of COVID-19, we will waive cost sharing (copays, coinsurance and deductibles) for COVID-19 office visits, including telehealth visits, initial office visits, post-inpatient transitional visits and other visits where COVID-19 is on the claim as a diagnosis. Office visits for conditions not related to COVID-19 are not waived for cost sharing, such as an existing condition or newly diagnosed conditions not related to COVID-19.

  • Individual and Group Market Fully Insured health plans
    From Feb. 4, 2020 through Dec. 31, 2020, UnitedHealthcare will waive cost sharing (copays, coinsurance and deductibles) for in- and out-of-network emergency and medically necessary non-emergency ground ambulance transportation for COVID-19-related services. UnitedHealthcare will also waive cost sharing for ground transportation from facility to facility (acute to acute or acute to post-acute) for patients with a positive COVID-19 diagnosis.

  • Self-Funded Individual and Group Market health plans   
    We will work with self-funded customers who want us to implement a similar approach on their behalf. Member cost sharing will apply.

  • Medicare Advantage 
    Coverage and cost sharing will be adjudicated in accordance with the member’s benefit plan.

  • Medicaid
    Coverage and waiver of cost share is subject to state regulations. 

Resources

Care providers can connect to the latest Centers for Disease Control and Prevention (CDC) guidance for health professionals, as well as travel advisories from the U.S. State Department.

We’re listening.

We’re committed to keeping you up to date on COVID-19 – we’re monitoring your inquiries and working hard to answer your questions. Let us know how we’re doing.

We’ll be making daily updates to this site. Be sure to check back often for the latest information. 


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Disclaimer:

The benefits and processes described on this website apply pursuant to federal requirements and UnitedHealthcare national policy during the national emergency.  Additional benefits or limitations may apply in some states and under some plans during this time.

We will adjudicate benefits in accordance with the member’s health plan.

Medicaid Providers: UnitedHealthcare will reimburse out-of-network providers for COVID-19 testing-related visits and COVID-19 related treatment or services according to the rates outlined in the Medicaid Fee Schedule.