Insurers' Testing: What Private Insurers Test And Why

Private insurers test a variety of things, from COVID-19 vaccines and at-home tests to cancer screening tests and auto insurance rates. Private health insurance companies, for example, are mandated to cover COVID-19 vaccinations and tests for most people, though this may depend on the specific insurance plan. Private auto insurers, on the other hand, have been increasing their premium rates by double digits in recent years. Additionally, private insurers are required to cover certain cancer screening tests, but the extent of coverage can vary by state and insurance provider.

Cancer screening tests

The Affordable Care Act (ACA) requires private insurers to cover the costs of certain cancer screening tests, although this does not apply to plans that were in place before the ACA was passed.

Breast Cancer Screening

Screening mammography is recommended for women aged 40-74, especially those aged 50-69, to reduce the risk of death from breast cancer. Women with a high risk of breast cancer may also undergo a breast MRI imaging test in addition to mammography.

Cervical/Gynecologic Cancer Screening

Human papillomavirus (HPV) tests and Pap tests are recommended for women aged 21-65. These tests can be used alone or in combination to detect abnormal cells that could lead to cervical cancer.

Colorectal Cancer Screening

Colorectal cancer screening is recommended for adults at average risk aged 45-75. Tests such as colonoscopy, sigmoidoscopy, and stool tests (including high-sensitivity fecal occult blood tests and fecal immunochemical tests) can help detect colorectal cancer early and identify abnormal colon growths that can be removed before becoming cancerous.

Lung Cancer Screening

Low-dose helical computed tomography, a type of CT scan, is recommended for current or former heavy smokers aged 50-80 to reduce the risk of lung cancer deaths.

Prostate Cancer Screening

The prostate-specific antigen (PSA) blood test and digital rectal exam (DRE) are used to screen for prostate cancer, particularly for African Americans and those with a family history of the disease. However, expert groups advise against routine PSA testing for men at average risk due to the potential for overdiagnosis and false-positive results.

Other Screening Tests

Other cancer screening tests that may be offered include the alpha-fetoprotein blood test for liver cancer, the CA-125 blood test for ovarian cancer, and skin cancer checks.

COVID-19 vaccines

Private Insurance

Private health insurance plans, obtained either through an employer or the individual/family market, typically cover COVID-19 vaccines without any cost-sharing. The CARES Act mandated comprehensive coverage of COVID-19 vaccination for most people with private health insurance, including non-grandfathered individual and employer-sponsored plans. This requirement remains in effect even though the CARES Act has expired. However, it is important to note that grandfathered health plans (plans purchased on or before March 23, 2010) are not required to cover the cost of the COVID-19 vaccine or its administration.

Medicare

Medicare covers COVID-19 vaccines for individuals 65 and older. Medicare Part B covers the COVID-19 vaccine, and providers participating in Medicare cannot charge beneficiaries for the vaccine. Medicare Advantage plans must also cover COVID-19 vaccines as a free benefit if you use an in-network provider. If you go out of network, you may be subject to a copayment. Additionally, Medicare covers lab tests for COVID-19 diagnostic tests ordered by a healthcare provider without cost-sharing.

Medicaid/CHIP

Beginning in October 2023, individuals with coverage from Medicaid and CHIP are guaranteed coverage of all vaccines recommended by the Advisory Committee on Immunization Practice at no cost to them. This includes COVID-19 vaccines.

Uninsured Individuals

For those without health insurance, there may be local immunization programs that provide low- or no-cost COVID-19 vaccines. These programs may be run by local health departments or community organizations. Additionally, free COVID-19 testing and treatment options may be available through federal programs such as HRSA-supported health centers.

At-home COVID-19 tests

The Biden-Harris Administration has required insurance companies and group health plans to cover the cost of at-home COVID-19 tests, increasing access to free tests. This means that people with private health insurance coverage can get at-home COVID-19 tests for free. This requirement has been in place since January 15, 2022.

Under this requirement, insurance companies and health plans must cover 8 free over-the-counter at-home tests per covered individual per month. This means that a family of four, all on the same plan, would be able to get up to 32 of these tests covered by their health plan per month. There is no limit on the number of tests, including at-home tests, that are covered if ordered or administered by a healthcare provider following an individualized clinical assessment.

The Biden-Harris Administration is incentivizing insurers and group health plans to set up programs that allow people to get over-the-counter tests directly through preferred pharmacies, retailers, or other entities with no out-of-pocket costs. Insurers and plans would cover the costs upfront, eliminating the need for consumers to submit a claim for reimbursement. When plans and insurers make tests available for upfront coverage through preferred pharmacies or retailers, they are still required to reimburse tests purchased by consumers outside of that network, at a rate of up to $12 per individual test (or the cost of the test, if less than $12).

As of January 2022, about half of the top insurers were implementing their testing coverage policy using only reimbursement. Some insurers offer an online option for submitting reimbursement forms, while others require receipts and a form to be mailed in, along with the product barcode information.

Auto insurance rates

Age and Gender

Age plays a crucial role in determining auto insurance rates, with younger drivers often facing higher premiums due to their lack of driving experience. Seniors generally pay the lowest rates, while teenage drivers are among the most expensive to insure. Additionally, men, especially those in their mid-20s, often pay more for auto insurance than women, although some states prohibit considering gender when setting rates.

Driving Record

A clean driving record can result in lower auto insurance rates. Conversely, accidents, speeding tickets, and DUIs can significantly increase premiums. Drivers with multiple violations may even be classified as high-risk and face licence suspension or revocation.

Credit Score

In most states, credit history is a significant factor in determining auto insurance rates. Drivers with poor credit tend to pay higher premiums, as research suggests they are more likely to file costly claims. However, some states restrict the use of credit information in setting auto insurance rates.

Vehicle Type and Features

The type of vehicle you drive also impacts your auto insurance rate. Newer or leased vehicles may require additional coverages, such as comprehensive and collision insurance. The vehicle's year, make, model, and safety features can all influence the cost of insurance.

Location

Coverage Level and Deductible

The level of coverage you choose and the deductible amount will also impact your auto insurance rate. Higher coverage limits and lower deductibles typically result in higher premiums.

Insurance Company

Different insurance companies can offer significantly varying rates for the same driver. It is crucial to compare quotes from multiple providers, as the same driver may find that one company offers much cheaper rates than another.

Discounts

Insurance companies offer various discounts that can lower your auto insurance rate. These include discounts for good students, safe drivers, bundling home and auto policies, paying annually instead of monthly, and more.

When shopping for auto insurance, it is essential to compare quotes from multiple providers, consider the company's reputation and customer service, and ensure you are getting the coverage you need at a price that fits your budget.

Home insurance rates

Location

The location of your home plays a significant role in determining insurance rates. Insurers consider the threat of natural disasters, proximity to the coast, and other geographical factors when calculating premiums. For example, homes in areas prone to hurricanes, wildfires, or floods may have higher insurance rates.

Home Characteristics

The physical characteristics of your house also affect insurance rates. This includes the materials used in construction, the age and condition of the roof, the size of the home, the presence of any custom features, and whether the house is up-to-date with current building codes. Older homes or those with unique features may require additional coverage, increasing the cost.

Coverage Amount and Type

The amount of coverage you choose will impact your insurance rates. A typical homeowners insurance policy includes dwelling coverage, which pays for damage to the main structure, and other structures coverage for unattached buildings like sheds. Personal property coverage protects your belongings, while loss of use coverage provides funds for additional living expenses if you need to temporarily move during repairs. Higher coverage limits will result in higher insurance rates.

Additionally, you may opt for extra coverage for events that a standard policy doesn't cover, such as floods, earthquakes, or backed-up drains. This supplementary coverage will increase your insurance rates.

Deductible Amount

The deductible is the amount you pay out of pocket before your insurance coverage kicks in. A higher deductible generally leads to lower insurance rates, as you are assuming more of the risk. On the other hand, choosing a lower deductible means you'll pay higher premiums but will have a reduced financial burden in the event of a claim.

Credit Score and Claims History

Your credit score and claims history can also impact your home insurance rates. Insurers often view a higher credit score as an indication of lower risk, which may result in lower premiums. Additionally, if you have made multiple claims in the past, insurers may consider you a higher risk and increase your rates accordingly.

Frequently asked questions