Health plans must pay for all types of preventive care, including a pill to prevent H.I.V., while an appeals court deliberates whether to strike down part of the Affordable Care Act.Lawyers reached a deal on Monday to keep the Affordable Care Act’s mandate requiring health plans to cover preventive care at no cost to patients.A district court in Texas ruled in March that part of the requirement was unconstitutional. The decision took effect immediately, meaning insurers no longer had to cover certain types of preventive care, including a pill to prevent the spread of H.I.V.The Fifth Circuit Court of Appeals temporarily stayed the ruling last month, bringing the health law’s provision back into effect. The appeals court also asked the two parties — a group of Texas residents and businesses challenging the law, and the Biden administration, which is defending it — to come to a compromise on how much of the mandate should be put on hold while it weighed its decision.The deal they reached leaves the provision almost fully in tact, requiring a vast majority of health plans to continue providing preventive care at no charge. The agreement includes an exemption for the small businesses and individuals challenging the provision; these entities will be allowed to use a plan that does not cover all preventive services if they can find a health insurer who offers it.The appellate court, which is expected to rule on the preventive care mandate’s constitutionality later this year, still has to approve the lawyers’ agreement.Health policy experts describe the mandate as one of the most transformative policies of the health law, known as Obamacare, because it could prevent worsening disease and higher costs later on. It is also popular, with 62 percent of the public recently saying it was “very important” that it stay in place.Before the Affordable Care Act’s passage, in March 2010, patients sometimes faced big bills for preventive care such as birth control or colonoscopies. Since the mandate took effect, studies have shown, more Americans have received blood pressure screenings, cholesterol screenings and flu vaccines.In March, Judge Reed O’Connor of the Federal District Court for the Northern District of Texas ruled that part of the mandate was unconstitutional because an independent panel advising the government on what benefits to cover did not have the proper authority to do so.Judge O’Connor’s ruling did not undo the entire preventive services mandate, but said it should not cover services that the panel, the United States Preventive Service Task Force, had recommended since 2010.The newer services included three types of screenings: one for anxiety in children, another for unhealthy drug use and a third for weight gain in pregnant women. The mandate also included a recommendation that people at high risk for H.I.V. take PrEP, a daily pill that is highly effective at preventing the transmission of the virus.The challengers in this case objected to covering PrEP, in particular, contending that the drug could “encourage homosexual behavior or intravenous drug use.”The deal may not have much practical impact on most Americans. When the initial ruling from the district court came down in March, many health plans announced that they would not change their benefits.Health plans typically have policies that span a full year, and it is unusual for them to change their members’ benefits in the middle of a contract. And insurers may be reluctant to take away a popular benefit that, in some cases, saves them money by preventing serious disease later on.Matt Eyles, the president of AHIP, the trade group representing health insurers, said in a statement shortly after the initial ruling that there would be “no immediate disruption in care or coverage.”The Blue Cross Blue Shield Association, which has health plans across the country, said in March that it would “strongly encourage their members to continue to access these services to promote their continued well-being.”

A ruling by a federal judge this week could set up yet another Supreme Court challenge to the Obamacare health law.On Thursday, a federal judge in Texas struck down a crucial Affordable Care Act policy: the mandate that private health insurers fully cover preventive care services at no cost to patients.The ruling took effect immediately and applies nationwide. It affects dozens of potentially lifesaving preventive health care services that the federal government recommends, including drugs that prevent H.I.V. transmission and screenings for adolescent depression.Health policy experts describe free preventive care as one of Obamacare’s most transformative policies because it took away a financial barrier to needed care for tens of millions of Americans. It is also one of the law’s more popular provisions, with 62 percent of the public recently saying it is “very important” that it stay in place.The new court ruling has already brought the Affordable Care Act back into the political fray, as Democrats quickly vowed to protect the law. The Biden administration plans to appeal the ruling, setting up the possibility of yet another presidential election cycle with a potential Supreme Court challenge to Obamacare looming.For now, even though the ruling has wide reach, most people aren’t likely to see their health benefits change overnight. Here is what consumers need to know about how the ruling could change health insurance in the United States.What did the judge find?The Affordable Care Act relies on three panels of health care experts to advise the government on what preventive services insurers must cover.Judge Reed O’Connor of the Federal District Court for the Northern District of Texas ruled that one of those panels, the United States Preventive Services Task Force, did not have constitutional authority to dictate what benefits health insurers must cover.Judge O’Connor had ruled in 2018 that the entire Affordable Care Act was unconstitutional, but the Supreme Court later overturned that decision and upheld the law. In this new case, Judge O’Connor found that having a panel of outside experts determine which preventive services should be covered violated the Constitution’s appointments clause, which says that legally significant decisions must be made by people who are part of a chain of authority up to the federal government.“The argument is that this is a body of private experts who serve in a volunteer capacity, who are not federal officers and are not properly appointed,” said Nicholas Bagley, an associate professor at the University of Michigan who has followed the Texas case closely.Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas.United States CourtsWho is affected by the ruling?The Affordable Care Act’s preventive services mandate potentially affects all Americans with private health coverage, not just those who get insurance through the Obamacare marketplaces.That is roughly 150 million people, most of whom get their health benefits through their jobs. The ruling does not appear to affect people with public insurance such as Medicare or Medicaid.What health benefits are at stake?The Texas ruling means that insurers no longer have to provide free coverage for any care the United States Preventive Services Task Force has recommended since 2010.In that time, the federal task force has endorsed at least four new types of preventive care. This includes three new type of screenings: one for anxiety in children, another for unhealthy drug use and a third for weight gain in pregnant women. It also includes a recommendation for PrEP, a daily pill that is highly effective at preventing the transmission of H.I.V.The task force has also updated much of its older guidance. For example, it has repeatedly updated its recommendations on heart disease to endorse the use of statins in certain adult populations. Under the Texas ruling, insurers would not have to follow the newer guidance and could instead provide free coverage for whatever recommendations were made in 2009 or earlier.The ruling does not affect all preventive care. Insurers are still required to cover all types of birth control, for example, and all recommended vaccines (including the Covid-19 vaccine) at no cost to patients. They are also still required to cover mammograms, pap smears and other common screenings the task force had recommended before 2010, but they will not have to follow any of its newer guidance on when those tests are appropriate.Will health insurance plans change immediately?Since the ruling took effect immediately and applies nationwide, health insurers could legally start applying co-payments and deductibles to the newer types of preventive health care. But health policy experts and insurance plans say they do not expect many consumers to experience an immediate change to their benefits.That is because health plans typically have policies that span a full year, and it is unusual for them to change member benefits in the middle of a contract, especially when the court case is still ongoing. Insurers may be reluctant to immediately take away a popular benefit that, in some cases, saves them money by preventing serious disease later on.Matt Eyles, the president of AHIP, the trade group representing health insurers, said in a statement on Thursday that “there will be no immediate disruption in care or coverage.”What happens next?A demonstration in support of the Affordable Care Act outside the Supreme Court in 2020.Anna Moneymaker for The New York TimesThe Biden administration plans to appeal the decision, according to a court filing made Friday afternoon. Experts also expect the federal government to pursue a stay of the ruling while the appeals process plays out, although the White House has not yet commented on when it will do so.A stay would put the Texas court’s decision on hold and bring the preventive care mandate back into effect until higher courts can weigh in on the case.Mr. Bagley said that if the Texas decision is stayed, the case would probably take years to wind its way to the Supreme Court because the issue would be less urgent.But if a stay is not issued, the case could move quickly and potentially reach the Supreme Court before the 2024 election.“It could set off a bit of a race to the Supreme Court,” he said.In a Thursday briefing, the White House press secretary, Karine Jean-Pierre, said the Biden administration “will continue to fight to improve health care and make it more affordable for hard-working families, even in the face of attacks from special interests.”Democrats have recently found political success in defending the Affordable Care Act, particularly since Republican efforts to repeal the law in 2017 failed. Obamacare has steadily become more popular, and this new lawsuit could make it a more prominent issue in the 2024 presidential campaign.Republicans were mostly silent on the ruling, a sign that dismantling the Affordable Care Act may have become a losing issue for the party. Top congressional Democrats were quick to defend the Affordable Care Act. Senator Patty Murray of Washington said in a Thursday statement, “The Affordable Care Act’s protections have repeatedly been upheld in the face of nonstop attacks,” adding, “I am not new to this fight, and I have no intention of backing down now.”

As some insurers focus on encouraging vaccination, temporary waivers that kept patient costs low are expiring.Americans will most likely pay significantly more for Covid medical care during this new wave of cases — whether that’s a routine coronavirus test or a lengthy hospitalization.Earlier in the pandemic, most major health insurers voluntarily waived costs associated with a Covid treatment. Patients didn’t have to pay their normal co-payments or deductibles for emergency room visits or hospital stays.Most Covid tests were free, too.The landscape has since changed, as the pandemic persists into its second year. Federal law still requires insurers to cover testing at no cost to the patient when there is a medical reason for seeking care, such as exposure to the disease or a display of symptoms. But more of the tests sought now don’t meet the definition of “medical reason” and are instead for monitoring.And insurers are now treating Covid more like any other disease, no longer fully covering the costs of care. Some businesses, like Delta Air Lines, are planning to charge unvaccinated employees higher rates for insurance, citing in part the high hospitalization costs for Covid cases.“Insurers are confronting the question about whether the costs of Covid treatment should fall on everyone, or just the individuals who have chosen not to get a vaccine,” said Cynthia Cox, a vice president at the Kaiser Family Foundation who has researched how insurers are covering Covid treatment.The federal rules that make coronavirus testing free include exemptions for routine workplace and school testing, which has become more common as students head back to the classroom and as companies mandate regular testing for unvaccinated workers.Because insurers are not required to cover that regular testing, some patients have already received testing bills as high as $200 for routine screenings, according to documents that patients have submitted to a New York Times project tracking the costs of Covid testing and treatment. If you’ve received a bill, you can submit it here.Some of the highest bills, however, will probably involve Covid patients who need extensive hospital care now that most insurers no longer fully cover those bills. Seventy-two percent of large health plans are no longer making Covid treatment free for patients, a recent study from the Kaiser Family Foundation found.This includes Blue Cross Blue Shield of Florida, the largest health plan in a state experiencing one of the country’s worst outbreaks. On Wednesday, Florida Blue began requiring patients to pay their normal deductibles and co-payments for Covid treatment. Toni Woods, a spokeswoman, said the plan was now focused on encouraging vaccinations.“When the Covid-19 pandemic began last year, we implemented several emergency provisions to temporarily help our members,” she said in a statement. “Medical diagnostic testing for Covid-19 as well as vaccinations continue to be available to members at $0 cost share.”Oscar Health, which sells coverage in Florida and 14 other states, also ended free Covid treatment this week. It cited the widespread availability of the vaccine as a key reason.“We started waiving cost sharing for Covid-19 treatment at the peak of the pandemic in 2020, when there were few options available for those who fell ill with the virus,” said Jackie Khan, an Oscar spokeswoman. “We believe that the Covid vaccine is our best way to beat this pandemic, and we are committed to covering it and testing at $0 for our members.”The new policies generally apply to all patients, including the vaccinated; people who get sick with a breakthrough infection; and children under 12, who are not yet eligible for the vaccine.“If you have a small kid who gets Covid at school and ends up at the I.C.U., that family is going to now be stuck with the bill even though that patient did not have the ability to get vaccinated,” said Dr. Kao-Ping Chua, a pediatrician at the University of Michigan who researches Covid care costs.The average Covid hospitalization costs approximately $40,000, researchers have found. A lengthy hospital stay — one that requires time in the intensive care unit, or a transfer by air ambulance — can cost many multiples more. Most insured patients won’t pay that entire bill; they will face whatever share they owe through deductibles and co-payments.Dr. Chua and his colleagues published research this summer finding that, among patients who had to pay a share of their Covid hospitalization, the average costs were $3,800.“There were some patients where it was $10,000 and others where it was $500,” he said. “It gives you some semblance of what things will now look like without the waivers.”Surprise bills for routine Covid testing could be smaller but more common, as schools and workplaces increasingly rely on regular screening to prevent coronavirus from spreading.At many workplaces, unvaccinated workers must submit to monitoring at least weekly. Some employers, including the federal government, plan to fully cover the costs of those tests. But others, including some hotels and universities, will ask unvaccinated workers to bear some or all of the testing costs.Rebecca Riley recently received a $200 bill from a laboratory with an unfamiliar name. When she called to inquire about the charge, she learned it was a fee for a Covid test. Her son, a high school student, is regularly tested at his Los Angeles-area high school.“I didn’t expect to get any bills,” she said. “I feel stupid, but I’d heard the tests were free.”Ms. Riley contacted her insurer about the charge, and it agreed to pay the full amount. But she now worries about future surprise testing bills. “I really feel for the families that won’t be able to pay,” she said.

Start with a web search. Consider a third-party tool. Expect frustration.This year, some Americans can do something that was previously impossible: look up the price of care before going to the hospital.A new federal rule requires hospitals to post the prices they negotiate with private insurers.The data is a rich source of new information. We used it to show that some insurers are paying twice or three times as much as their competitors for basic services — and that paying cash rather than using your coverage can often lead to a lower price.But most hospitals have not yet posted the required data. Even when they have, finding it can take time and legwork. Also, you may need to be a computer programmer to open it.“Get some coffee and hydrate, because it’s going to be a while,” said Touré McCluskey, a co-founder of the health start-up Redu Health, which has collected some of the data files. “There is information out there, but it’s not consumer-friendly.”To help those who want to try, we interviewed several researchers who have spent months collecting the data. They recommended several simple strategies.What you’ll need to know to startBefore you start looking for prices, you’ll want to know what kind of health insurance you have — both the name of your insurer and also details like whether you picked an H.M.O. plan during open enrollment or went with a P.P.O. option.Insurers often have a half-dozen rates within the same hospital. Some are specific to which plan you picked and to whether you bought the insurance through the Obamacare marketplace or a specific employer. Others have to do with what network you opted into when you signed up for coverage.Knowing the type of insurance you have will help you make the most sense of which prices in the data apply to you.Then do a web searchFor most hospitals, the data is posted on a page labeled “price transparency.” Many researchers say they begin looking for price files through a search on Google for that phrase and the hospital’s name.“That search should lead you to a top result that has something to do with price estimates billing, or patient information,” said Morgan Henderson, a health economist at the University of Maryland-Baltimore County who worked with The Upshot to collect the price files used in our recent articles. “Sometimes what you want is way at the bottom of that page, or you have to follow a few links.”The page should look something like this one from MedStar Hospital Center, the largest hospital in Washington, D.C.The hospital’s price transparency site will probably have multiple sections and links, and the labeling of the price files isn’t always clear. You’ll want to look for something like a “comprehensive machine-readable file” or “negotiated price list.”It’s also worth opening up files that are described as containing “standard charges” or a “chargemaster.” Here’s how those look at Indiana University Health:When you open the files, you see it actually has the hospital’s negotiated rates and cash prices, too.Here’s what you’re looking forThe government has not created a standard format for hospitals to report their price data, and each hospital seems to take a slightly different approach.Some post their data in Excel or CSV files, which you can open using free software like Google Sheets. But some use JSON files, a data format typically used by computer programmers and professional data scientists that ordinary people might struggle to open.“I have training in health economics and policy, and I’m working on a machine with a lot of memory space,” said Morgane Mouslim, also a health economist at the University of Maryland-Baltimore County, who helped The Upshot collect and standardize data files. “If a file isn’t in Excel, you might need additional software.”A typical data set lists prices by procedure for each insurer, like this one from the Hospital of the University of Pennsylvania:The five-digit figures to the very left of this spreadsheet are CPT codes, which hospitals use to describe each service they offer. Most files also have short descriptions for each code, but they can be confusing. Code U0003, for example, is translated as “PR COV 19 AMP PRB HIGH THRUPUT” — a jargony way of describing a coronavirus test.To look up the cost of a specific service you expect to get at a hospital, you most likely have to call the facility and ask what CPT codes it will bill for your visit.You may also see other numerical codes, sometimes labeled procedure codes or revenue codes, like in the file below from Baptist Medical Center in Little Rock, Ark. You probably don’t need to pay much attention to those and should focus on the CPT codes. (If the CPT codes are not labeled, you can generally recognize them as the ones that are five digits.)Usually, you should see dollar figures representing real prices. But you could run across files where the price is listed as “variable,” meaning it could differ for two patients with the same insurance who received the same care under different circumstances.Molly Smith, vice president for public policy at the American Hospital Association, gave the example of a patient who comes to the hospital for a flu vaccine versus one who happens to get one while there for surgery.“In the contract we generally negotiate the price of the primary service, but if it’s a secondary service, maybe 15 percent is taken off,” she said. “It’s not possible to reflect that in these files.”The files should also include two other prices: the “charge” or “gross price,” which is the sticker price for a given service that hospitals often use as a baseline for negotiating discounts. There should also be the “cash” price, which is what the hospital bills patients who don’t use insurance. Whether this price is available to patients with insurance varies from hospital to hospital. Some low-income patients may qualify for even steeper discounts based on how little they earn.Once you find the data point you’re looking for, there may be additional work to understand it. Most hospitals list the prices as dollar figures, but some display the data as a percent of the gross charge — meaning patients will need to do math to understand their costs.What if I can’t find anything?Most hospitals have not posted the required data, so that may happen a lot.For example, on N.Y.U. Langone’s price transparency website, you can find only standard charges and a patient estimator tool, which uses information about your insurance plan to generate a custom estimate of how much you’ll pay for a certain procedure.Those tools provide limited information. The standard charges can tell you the maximum you could pay for a given service, and the patient estimator shows the out-of-pocket costs associated with simple services like mammograms and blood tests. When a Times reporter tried to use N.Y.U.’s site in late July, however, it generated error messages for all services explored.A representative for N.Y.U. Langone declined to comment on why the hospital had not posted its full data.With compliance rates still low, the federal government is promising to increase enforcement. It has sent nearly 170 warning letters to noncompliant hospitals, and plans to increase the penalties for noncompliance from $109,500 annually to as much as $2 million.If you believe a hospital has not posted the required information, you can file a complaint with the federal government notifying it of the issue.Soon, third-party sites might helpSome health care experts say the large data files will become more useful after third-party data companies clean and organize the information, so that patients can search across multiple hospitals and health care services.One data transparency company, Turquoise Health, has already created a free price lookup tool. Others are expected soon.See something surprising? Tell us about it.The Times has looked into data sets from 60 hospitals so far. But many more are out there.If you notice something surprising in a hospital price file — exceptionally high prices, for example, or large variations in what a service costs — we’d love to hear about it. You can email us with what you’ve found.

Readers’ bills can help us understand the high costs of our health care system.Scott GelberThe New York Times is looking into the high costs of American health care and the wide price variation that patients face from one hospital or doctor’s office to another.And we need your help. Medical bills help us see the prices that hospitals and insurers have long kept secret. If you have a medical bill that surprised you — maybe because of a high price, or an unexpected charge — we’d love to review it. A reporter may follow up to learn more.

Get tested at a public facility. Question what services are being provided. And know your rights under federal law.Having a covid test in Houston this week.Callaghan O’Hare/ReutersThis is an updated version of an article first published on Nov. 13, 2020.The Delta-variant-driven wave of coronavirus infections is driving a new surge in testing — and that could mean more surprise medical bills.Congress wrote rules last spring to make most coronavirus testing free for all Americans. But patients, with or without insurance, have found holes in those new coverage programs.Federal law does not, for example, require insurers to cover the routine testing that a growing number of workplaces and schools are mandating. Some doctors and hospitals have tacked unexpected fees onto coronavirus testing bills, leaving patients with surprise charges ranging from a few dollars to over $1,000.In the past year, I’ve collected patients’ bills related to coronavirus. As part of that project, I’ve read through more than 100 patient stories about coronavirus tests. Many patients are happy to report no charge at all, while others have been billed large unexpected fees or denied claims related to coronavirus tests.[Have a bill you want to share? Submit it here.]The surprise bills have hit uninsured Americans as well as those with robust coverage. The health data firm Castlight estimates that 2.4 percent of coronavirus test bills leave some share of the charge to consumers, which means there could be millions of patients facing fees they did not expect.These are some simple steps you can take to lower your chances of becoming one of them.If you can, get tested at a public siteMany states, counties and cities/towns now have public testing facilities. Very few patients have reported surprise medical bills from those testing sites (although it’s not impossible). You can typically use your state health department website to find public testing options.If a public test site isn’t an option where you live, you might consider your primary care doctor or a federally qualified health clinic. The largest surprise coronavirus test bills I’ve reviewed tend to come from patients who are tested in hospitals and free-standing emergency rooms. Those places often bill patients for something called a facility fee, which is the charge for stepping into the room and seeking service.Patients are finding that these fees can pop up even when they don’t actually set foot in the facility. Multiple patients at one Texas emergency room had $1,684 facility fees tacked onto their drive-through coronavirus tests. A patient in New York faced a $1,394 charge for her test at a tent outside a hospital. The majority of the bill was the facility fee. The investigative news site ProPublica has reported on how facility fees can sometimes cost as much as 10 times the coronavirus test itself.If you get your test at a primary care provider, or at a public test site, you shouldn’t have to worry about that type of billing. They typically do not charge facility fees for coronavirus tests or any other types of care.Ask your provider what they’ll bill you forWhen patients receive a surprise medical bill related to a coronavirus test, often the charges they face are not for the test itself, but instead for other services that the patient may not have known about.Some of these make sense: Many bills for coronavirus tests have fees for the doctor visit that went along with it. Others make less sense, like the bills that include screenings for sexually transmitted diseases. Those extra fees appear to be a bit more common in emergency rooms, or when health providers send their samples to outside laboratories. But they can happen at public testing sites, too: One Connecticut doctor regularly tested patients for dozens of illnesses at a town drive-through. The patients thought they were simply getting coronavirus tests.To avoid those extra charges, ask your provider what diseases they will screen for. It can be as simple as saying: “I understand I’m having a coronavirus test. Are there any other services you’ll bill me for?” Having a better understanding of that up front can save you a headache later, and you can make an informed decision about what care is actually needed. If your providers can’t tell you what they’ll bill for, that may be a signal you want to seek care elsewhere.Uninsured? Ask your doctor to bill the government, not youUninsured patients have faced coronavirus bills upward of $1,000, according to billing documents reviewed by The New York Times.That type of billing is legal: Health care providers are not required to provide free coronavirus tests to Americans who lack health insurance. But they do not necessarily have to bill patients directly. The federal government has set up a provider relief fund: Health providers can seek reimbursement for coronavirus testing and treatment provided to those without coverage. Once again, it pays to ask ahead of time how providers handle uninsured patients and whether they submit to the fund. Unfortunately, they are not required to do so — and could continue to pursue the debt.You should also be aware that 17 states have authorized their state Medicaid plans to cover coronavirus test costs for uninsured Americans. This means your state government can pay the bill instead of you. You can find out if you live in one of these states here.To challenge a surprise bill, know your rights under federal lawNew federal laws regulate how health providers and insurers can bill patients for coronavirus tests. Understanding how they work can help you push back on charges that may not be allowed.The new laws state that health insurers must cover coronavirus tests ordered by a doctor without any cost to the patients. This means that standard deductibles and co-payments you’d face for other services do not apply.There is one important exception in those laws: Insurers do not have to cover routine coronavirus testing ordered by a school or workplace. If your job mandates that you get tested each week, for example, it is up to your health plan whether it wants to pay those bills.For that type of testing, you’ll want to be especially careful about where you get tested, and ask more questions about the fees you may have to pay. Some employers are already directing their workers to be tested at public sites, in part to reduce the possibility of surprise charges.For the coronavirus tests that insurers do have to cover, there is still a bit of a gray area. The law requires insurers to cover any other services that are necessary to get the coronavirus test, but doesn’t define what makes the cut. Most experts agree that a doctor visit fee is a pretty clear example of a service that ought to qualify, and that patients facing those types of bills ought to appeal to their insurer for coverage. Other services, like a flu test or even an X-ray conducted alongside a coronavirus test, present a murkier situation. If you’re facing fees like those, you might want to enlist your doctor to tell the insurer why the additional care was needed.One last thing to know about the federal laws is that they require insurers to fully cover out-of-network coronavirus tests. This can be especially important for patients who go to an in-network doctor but unknowingly have their sample sent to an out-of-network laboratory, a situation I’ve seen many times. Your health plan’s typical rules for out-of-network care should not apply to the coronavirus test. They can, however, be applied to other parts of the test experience (the doctor visit fee, for example), so it is safer to stick with in-network providers whenever possible.Receive an unexpected bill? Medical codes could be the culpritOne other issue to look for is what billing codes your doctor used for the test visit. Many of the surprise bills I’ve reviewed involve a doctor charging a visit fee, then sending the test to an outside laboratory that submits its own claim. The health plan might apply a co-pay to the doctor’s visit because it’s not clearly linked in billing records to the coronavirus test. In this case, you may need to work with your health provider to get your visit recoded to show a coronavirus test occurred.Tell us what happened to you. It helps our journalism.Nearly everything I know about coronavirus test billing comes from reading the bills that hundreds of Times readers have sent describing their experiences. If you receive a bill related to coronavirus testing and treatment, we ask that you take a moment to submit it here. It will help me continue to report on the types of fees patients face, and can help identify areas of the country where patients are facing unusually high fees.

Get tested at a public facility. Question what services are being provided. And know your rights under federal law.Having a covid test in Houston this week.Callaghan O’Hare/ReutersThis is an updated version of an article first published on Nov. 13, 2020.The Delta-variant-driven wave of coronavirus infections is driving a new surge in testing — and that could mean more surprise medical bills.Congress wrote rules last spring to make most coronavirus testing free for all Americans. But patients, with or without insurance, have found holes in those new coverage programs.Federal law does not, for example, require insurers to cover the routine testing that a growing number of workplaces and schools are mandating. Some doctors and hospitals have tacked unexpected fees onto coronavirus testing bills, leaving patients with surprise charges ranging from a few dollars to over $1,000.In the past year, I’ve collected patients’ bills related to coronavirus. As part of that project, I’ve read through more than 100 patient stories about coronavirus tests. Many patients are happy to report no charge at all, while others have been billed large unexpected fees or denied claims related to coronavirus tests.[Have a bill you want to share? Submit it here.]The surprise bills have hit uninsured Americans as well as those with robust coverage. The health data firm Castlight estimates that 2.4 percent of coronavirus test bills leave some share of the charge to consumers, which means there could be millions of patients facing fees they did not expect.These are some simple steps you can take to lower your chances of becoming one of them.If you can, get tested at a public siteMany states, counties and cities/towns now have public testing facilities. Very few patients have reported surprise medical bills from those testing sites (although it’s not impossible). You can typically use your state health department website to find public testing options.If a public test site isn’t an option where you live, you might consider your primary care doctor or a federally qualified health clinic. The largest surprise coronavirus test bills I’ve reviewed tend to come from patients who are tested in hospitals and free-standing emergency rooms. Those places often bill patients for something called a facility fee, which is the charge for stepping into the room and seeking service.Patients are finding that these fees can pop up even when they don’t actually set foot in the facility. Multiple patients at one Texas emergency room had $1,684 facility fees tacked onto their drive-through coronavirus tests. A patient in New York faced a $1,394 charge for her test at a tent outside a hospital. The majority of the bill was the facility fee. The investigative news site ProPublica has reported on how facility fees can sometimes cost as much as 10 times the coronavirus test itself.If you get your test at a primary care provider, or at a public test site, you shouldn’t have to worry about that type of billing. They typically do not charge facility fees for coronavirus tests or any other types of care.Ask your provider what they’ll bill you forWhen patients receive a surprise medical bill related to a coronavirus test, often the charges they face are not for the test itself, but instead for other services that the patient may not have known about.Some of these make sense: Many bills for coronavirus tests have fees for the doctor visit that went along with it. Others make less sense, like the bills that include screenings for sexually transmitted diseases. Those extra fees appear to be a bit more common in emergency rooms, or when health providers send their samples to outside laboratories. But they can happen at public testing sites, too: One Connecticut doctor regularly tested patients for dozens of illnesses at a town drive-through. The patients thought they were simply getting coronavirus tests.To avoid those extra charges, ask your provider what diseases they will screen for. It can be as simple as saying: “I understand I’m having a coronavirus test. Are there any other services you’ll bill me for?” Having a better understanding of that up front can save you a headache later, and you can make an informed decision about what care is actually needed. If your providers can’t tell you what they’ll bill for, that may be a signal you want to seek care elsewhere.Uninsured? Ask your doctor to bill the government, not youUninsured patients have faced coronavirus bills upward of $1,000, according to billing documents reviewed by The New York Times.That type of billing is legal: Health care providers are not required to provide free coronavirus tests to Americans who lack health insurance. But they do not necessarily have to bill patients directly. The federal government has set up a provider relief fund: Health providers can seek reimbursement for coronavirus testing and treatment provided to those without coverage. Once again, it pays to ask ahead of time how providers handle uninsured patients and whether they submit to the fund. Unfortunately, they are not required to do so — and could continue to pursue the debt.You should also be aware that 17 states have authorized their state Medicaid plans to cover coronavirus test costs for uninsured Americans. This means your state government can pay the bill instead of you. You can find out if you live in one of these states here.To challenge a surprise bill, know your rights under federal lawNew federal laws regulate how health providers and insurers can bill patients for coronavirus tests. Understanding how they work can help you push back on charges that may not be allowed.The new laws state that health insurers must cover coronavirus tests ordered by a doctor without any cost to the patients. This means that standard deductibles and co-payments you’d face for other services do not apply.There is one important exception in those laws: Insurers do not have to cover routine coronavirus testing ordered by a school or workplace. If your job mandates that you get tested each week, for example, it is up to your health plan whether it wants to pay those bills.For that type of testing, you’ll want to be especially careful about where you get tested, and ask more questions about the fees you may have to pay. Some employers are already directing their workers to be tested at public sites, in part to reduce the possibility of surprise charges.For the coronavirus tests that insurers do have to cover, there is still a bit of a gray area. The law requires insurers to cover any other services that are necessary to get the coronavirus test, but doesn’t define what makes the cut. Most experts agree that a doctor visit fee is a pretty clear example of a service that ought to qualify, and that patients facing those types of bills ought to appeal to their insurer for coverage. Other services, like a flu test or even an X-ray conducted alongside a coronavirus test, present a murkier situation. If you’re facing fees like those, you might want to enlist your doctor to tell the insurer why the additional care was needed.One last thing to know about the federal laws is that they require insurers to fully cover out-of-network coronavirus tests. This can be especially important for patients who go to an in-network doctor but unknowingly have their sample sent to an out-of-network laboratory, a situation I’ve seen many times. Your health plan’s typical rules for out-of-network care should not apply to the coronavirus test. They can, however, be applied to other parts of the test experience (the doctor visit fee, for example), so it is safer to stick with in-network providers whenever possible.Receive an unexpected bill? Medical codes could be the culpritOne other issue to look for is what billing codes your doctor used for the test visit. Many of the surprise bills I’ve reviewed involve a doctor charging a visit fee, then sending the test to an outside laboratory that submits its own claim. The health plan might apply a co-pay to the doctor’s visit because it’s not clearly linked in billing records to the coronavirus test. In this case, you may need to work with your health provider to get your visit recoded to show a coronavirus test occurred.Tell us what happened to you. It helps our journalism.Nearly everything I know about coronavirus test billing comes from reading the bills that hundreds of Times readers have sent describing their experiences. If you receive a bill related to coronavirus testing and treatment, we ask that you take a moment to submit it here. It will help me continue to report on the types of fees patients face, and can help identify areas of the country where patients are facing unusually high fees.

With the Delta variant surging, many companies decide that unvaccinated workers will need to get regular testing.Rhodes College, in Memphis, will start charging the unvaccinated students, faculty and staff an extra $1,500 per semester to cover the extra cost of covid testing.Andrea Morales for The New York TimesSpurred by rising Covid cases and the Delta variant’s spread, a wave of major employers announced the same rule for unvaccinated workers this week: They will need to submit to regular surveillance testing. The new requirement raises a thorny question: Who pays for those coronavirus tests?Doctors typically charge about $50 to $100 for the tests, so the costs of weekly testing could add up quickly. Federal law requires insurers to fully cover the tests when ordered by a health care provider, but routine workplace tests are exempt from that provision.“It’s really up to the employer,” said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms. “They can require employees to pick up the tab.”Employers have so far taken a range of approaches, from fully covering the costs to having unvaccinated workers pay full freight.The U.S. government will pay for its unvaccinated workers’ coronavirus testing, Karine Jean-Pierre, the deputy White House press secretary, said at a news briefing Friday.President Biden announced rules on Thursday that amount to a two-tier system for the country’s four million federal employees. Those who do not get vaccinated will have to social-distance, wear face coverings and comply with limits on official travel. Those who do get vaccinated will have no such requirements.The unvaccinated will also have to submit to regular coronavirus testing. Each federal agency will come up with a plan for testing its unvaccinated work force. The costs and procedures of each agency’s testing protocols will depend on the number of unvaccinated people they need to monitor.“The agencies are going to be implementing this program themselves, so they’ll be in charge of how that moves forward,” Ms. Jean-Pierre said.Among the employers taking a different approach is Rhodes College in Tennessee: It will have unvaccinated students, faculty and staff pay a $1,500 fee per semester to cover the costs associated with a weekly coronavirus testing program.Rhodes, a small liberal-arts college, estimates that three-quarters of its employees are vaccinated. It is still collecting information about the vaccination rate among its 2,000 students, and it strongly encourages vaccination. But it is waiting until full Food and Drug Administration approval of the vaccines before mandating them.“This is not a punishment,” said Meghan Harte Weyant, the college’s vice president for student life. “For students who choose to return to campus unvaccinated, they will have to cover their costs. This is intended to ensure that students who are vaccinated do not have to bear that cost.”Other employers are having workers chip in for the costs of coronavirus testing. MGM Resorts, which owns many hotels and casinos in Las Vegas, will charge a $15 co-pay for the testing at an on-site clinic for unvaccinated workers, multiple news outlets reported last week. Workers will also have the option to be tested at an outside provider.MGM Resorts did not respond to a New York Times request for comment on the new policy.These disparate approaches could provide a menu of options for workplaces still deciding who will pay for unvaccinated workers’ coronavirus tests, and how much.New York and California started testing requirements for unvaccinated state workers this week, but neither has specified who will pay for the service. Neither governor’s press office responded to a Times request for comment.Many states and cities still have free coronavirus testing sites that they started earlier in the pandemic. Long Beach, Calif., announced this week that it would require testing for unvaccinated city workers. In a statement to The Times on the new rule, the city said that workers “will have the option to do their mandated testing for free at the Long Beach Health Department” when the requirement takes effect in mid-August.But many Americans also get tests at doctor’s offices and pharmacies, which will typically bill patients and their insurance for the service..css-1xzcza9{list-style-type:disc;padding-inline-start:1em;}.css-3btd0c{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:1rem;line-height:1.375rem;color:#333;margin-bottom:0.78125rem;}@media (min-width:740px){.css-3btd0c{font-size:1.0625rem;line-height:1.5rem;margin-bottom:0.9375rem;}}.css-3btd0c strong{font-weight:600;}.css-3btd0c em{font-style:italic;}.css-w739ur{margin:0 auto 5px;font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:1.125rem;line-height:1.3125rem;color:#121212;}#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-family:nyt-cheltenham,georgia,’times new roman’,times,serif;font-weight:700;font-size:1.375rem;line-height:1.625rem;}@media (min-width:740px){#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-size:1.6875rem;line-height:1.875rem;}}@media (min-width:740px){.css-w739ur{font-size:1.25rem;line-height:1.4375rem;}}.css-9s9ecg{margin-bottom:15px;}.css-uf1ume{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-box-pack:justify;-webkit-justify-content:space-between;-ms-flex-pack:justify;justify-content:space-between;}.css-wxi1cx{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-flex-direction:column;-ms-flex-direction:column;flex-direction:column;-webkit-align-self:flex-end;-ms-flex-item-align:end;align-self:flex-end;}.css-12vbvwq{background-color:white;border:1px solid #e2e2e2;width:calc(100% – 40px);max-width:600px;margin:1.5rem auto 1.9rem;padding:15px;box-sizing:border-box;}@media (min-width:740px){.css-12vbvwq{padding:20px;width:100%;}}.css-12vbvwq:focus{outline:1px solid #e2e2e2;}#NYT_BELOW_MAIN_CONTENT_REGION .css-12vbvwq{border:none;padding:10px 0 0;border-top:2px solid #121212;}.css-12vbvwq[data-truncated] .css-rdoyk0{-webkit-transform:rotate(0deg);-ms-transform:rotate(0deg);transform:rotate(0deg);}.css-12vbvwq[data-truncated] .css-eb027h{max-height:300px;overflow:hidden;-webkit-transition:none;transition:none;}.css-12vbvwq[data-truncated] .css-5gimkt:after{content:’See more’;}.css-12vbvwq[data-truncated] .css-6mllg9{opacity:1;}.css-qjk116{margin:0 auto;overflow:hidden;}.css-qjk116 strong{font-weight:700;}.css-qjk116 em{font-style:italic;}.css-qjk116 a{color:#326891;-webkit-text-decoration:underline;text-decoration:underline;text-underline-offset:1px;-webkit-text-decoration-thickness:1px;text-decoration-thickness:1px;-webkit-text-decoration-color:#326891;text-decoration-color:#326891;}.css-qjk116 a:visited{color:#326891;-webkit-text-decoration-color:#326891;text-decoration-color:#326891;}.css-qjk116 a:hover{-webkit-text-decoration:none;text-decoration:none;}Federal law requires insurers to fully cover coronavirus tests ordered by health care providers, meaning the doctor cannot apply a deductible or co-payment to the service. Rules written by the Trump administration, and continued into the Biden administration, excluded routine workplace testing from that requirement.In practice, insurers do often end up covering employer-mandated tests — it’s hard to tell from a doctor’s bill whether a workplace ordered the care — but they could start reviewing cases of patients who suddenly have claims every week for the same service.“If they are starting to see a significant number of people who have these tests submitted every week, or twice a week, under federal law they would be within their authority to say this looks like routine workplace testing and not cover it,” said Professor Corlette of Georgetown.This means unvaccinated workers who have to obtain their own coronavirus testing could have to pay their own fees. Some patients have faced surprise medical bills for coronavirus tests, which can range from a few dollars to over $1,000.Some of those bills were the result of an employer-mandated test. In the last year, The Times has asked readers to send in their medical bills for coronavirus testing and treatment, and reviewed multiple cases of surprise charges for a workplace-required test.That includes Marta Bartan, who needed a coronavirus test to return to a job last summer working as a hair colorist in Brooklyn. As The Times reported, she received a $1,394 bill from a hospital running a drive-through site.“I was so confused,” she said at the time. “You go in to get a Covid test expecting it to be free. What could they have possibly charged me $1,400 for?”

The increase points to the program’s growing role not just as a safety net, but also as a foundation of U.S. health coverage.Medicaid enrollment rose sharply during the pandemic, with nearly 10 million Americans joining the public health program for the poor, a government report released Monday showed.Eighty million people were covered under Medicaid, a record. It reflected an increase of nearly 14 percent over the 12-month period ending Jan. 31. The figure also includes enrollment in the Children’s Health Insurance Program, which covers children whose parents earn too much for Medicaid, but too little to afford other coverage.The spike in enrollment demonstrates Medicaid’s increasingly important role not just as a safety net, but also as a pillar of the American health system, with fully a quarter of the population getting coverage through it.“The purpose of Medicaid is for times like this, when there is an economic downturn,” said Peggah Khorrami, a researcher with the Harvard T.H. Chan School of Public Health who has studied the program’s enrollment during the pandemic. “As people are losing jobs, that’s where Medicaid comes in.”The Affordable Care Act transformed Medicaid from a targeted health care benefit meant to help certain groups — expectant mothers, for example, and those with disabilities — to a much wider program providing largely free coverage to most people below a certain income threshold. A notable exception is the 12 states — mostly in the South — that have declined to expand Medicaid under the A.C.A.Medicaid, in which states and the federal government share the cost, covers all adults with income up to 138 percent of the poverty level, which would be about $17,420 for an individual to qualify this year.The expansion of Medicaid in most states since the bulk of the A.C.A. took effect in 2014 provided a public source of coverage for the newly unemployed that did not exist a decade ago. Adult enrollment in Medicaid grew twice as fast as child enrollment, suggesting that widespread job loss related to the pandemic created a huge group of newly eligible adults.“In past economic downturns, there has been substantial growth in Medicaid enrollment, but it was concentrated among children,” said Rachel Garfield, co-director of the Kaiser Family Foundation’s program on Medicaid and the uninsured. “This time, it’s interesting we’re seeing much of the enrollment happening among adults.”She also noted that Medicaid enrollment has increased much faster during the pandemic economic contraction than in previous downturns. Fewer than four million Americans joined the program in 2009, at the beginning of the Great Recession.There may also have been increased interest among uninsured Americans who were already eligible for Medicaid, but who decided to enroll only because of heightened health concerns during the pandemic.“The increase we are seeing is exactly how Medicaid works: The program steps in to support people and their families when times are tough,” the Medicare administrator, Chiquita Brooks-LaSure, said in a statement.Medicaid enrollment had been declining in the years leading up to the pandemic. More than a million children lost coverage between December 2017 and June 2019, a trend that rattled health care advocates. Many attributed the changes to new rules during the Trump administration that made it harder to sign up and remain signed up.That changed last spring, as the pandemic took hold and Congress gave states extra money to fund their Medicaid programs. Congress gave a 6.2 percent spending bump on the condition that states not disenroll patients or tighten eligibility requirements.A woman who gave birth, for example, would normally have lost coverage 60 days after delivery, but because of the legislation, she could stay on Medicaid for the length of the pandemic. Those rules remain in effect until the federal government declares the public health emergency over.Three states — Utah, Idaho and Nebraska — expanded Medicaid last year after voters approved ballot initiatives; those states saw especially large enrollment surges. A fourth, Oklahoma, will expand Medicaid to most low-income adults starting next month.Even after its growth under the Affordable Care Act, the Medicaid program has holes that are hard to fix. The 2012 Supreme Court decision that upheld the law’s individual insurance mandate also made expanding Medicaid optional for states.As a result, millions of low-income adults in the 12 holdout states, which include Florida and Texas, still have no coverage. A recent study in JAMA found that Medicaid enrollment increased faster during the pandemic in the states that participated in the expansion, most likely because many more people were eligible for coverage.Generous financial incentives offered through the most recent stimulus package have not been enough to persuade any of the 12 states to expand Medicaid, but top Biden administration officials say they remain hopeful that some will come on board.“We hope we can encourage them,” Xavier Becerra, the Health and Human Services secretary, said in a call with reporters last week. “We want to make sure they’re expanding care and it’s affordable.”

Such billing has been rare, but public concern about it may be contributing to hesitancy about getting the shot.The New York Times is investigating the costs associated with coronavirus testing, treatment and vaccination. You can read more about the project and submit your medical bills here.The Biden administration is reminding doctors, hospitals, pharmacies and insurers that it is illegal to bill patients for coronavirus vaccines, a letter obtained by The Times shows.The new warning responds to concerns among unvaccinated Americans that they could receive a bill with their shot. A recent Kaiser Family Foundation poll found that about a third of unvaccinated adults were unsure whether insurance covered the new vaccine.In New York City, Covid-19 vaccination is available in some subway stations. The vaccine is free, but concerns persist about cost, polling shows. Brendan Mcdermid/Reuters“We recognize that there are costs associated with administering vaccines — from staff trainings to vaccine storage,” Xavier Becerra, the Health and Human Services secretary, wrote in a letter to vaccinators and insurers. “For these expenses, providers may not bill patients but can seek reimbursement through Medicare, Medicaid, private insurance or other applicable coverage.”The letter warns that billing patients could lead to state or federal “enforcement actions,” but does not specify what the penalty would be.The federal government wrote strong consumer protections to ensure that patients do not have to pay for coronavirus vaccines.In stimulus legislation last spring, it barred insurers from charging patients co-payments or deductibles for the vaccines. The same law also created a fund that would cover the costs of vaccinating uninsured Americans.Layered on top of those legislative protections are the contracts that doctors and hospitals signed to receive vaccines. Those documents specify that vaccinators cannot bill patients for the service.The stronger protections appear to have worked. While many patients have encountered coronavirus bills for testing, there have been only a handful involving vaccines.Still, the rules are not foolproof, and some patients have faced illegal charges. In April, the Health and Human Services office of the inspector general published a letter saying it was “aware of complaints by patients about charges by providers when getting their Covid-19 vaccines.”A few patients have submitted bills showing surprise charges to a Times project collecting patient bills for testing, treatment and vaccination. The fees range from $20 to $850. If you received a bill for your coronavirus vaccine, you can submit it here.Patients who receive bills for coronavirus vaccines can challenge the charge. Those with health insurance can reach out to their plan to ask why they received a bill when two federal laws — the Families First Coronavirus Response Act and the CARES Act — outlaw it.A small subset of health plans is exempt from the laws. These “grandfathered” plans existed before the Affordable Care Act, and are not subject to requirements to fully cover the coronavirus vaccine or any other preventive service.But even those patients are still protected by the contract that doctors signed barring any billing. The doctors can send the outstanding charges to a new Coverage Assistance Fund created by the Biden administration last month specifically to address patient coverage gaps.Uninsured patients can direct their providers to bill the Covid-19 Uninsured Program, which was set up to cover those without coverage.If an insurer or doctor is unwilling to reverse a bill, patients can seek help from state regulators. State departments of insurance typically deal with complaints about whether health plans are not appropriately covering medical care, while state attorneys general tend to field complaints about possible inappropriate bills from doctors and hospitals.