NEW DATA: COVID-19 Test Price Gouging Continues

posted by AHIP

on November 16, 2020

Out-of-Network COVID-19 Test Costs Remain Significantly Higher than In-Network Charges

WASHINGTON, D.C. – Every day, COVID-19 continues to put pressure on America’s health care system and the patients and communities it serves.  Health insurance providers are responding to this crisis by taking decisive action to ensure that Americans have access to the diagnostic testing and treatment needed to effectively combat this virus.  However, data from a new survey conducted by America’s Health Insurance Plans (AHIP) shows that out-of-network COVID-19 test costs continue to rise, significantly exceeding in-network costs and ultimately jeopardizing affordability:

  • The average cost of a COVID-19 test in the commercial market is $130. In contrast, out-of-network cost more than $185 for nearly half of diagnostic tests and a third of antibody and antigen tests.
  • This represents a 10% increase in the share of high cost diagnostic and antibody tests since July. The share of COVID-19 tests administered out-of-network increased by 14%.
  • As much as 16% of out-of-network test claims were more than $390—three times the average cost.

These findings are based on a survey of health insurance providers in the commercial market conducted by AHIP to gather data on prices charged by out-of-network providers for diagnostic, antibody, antigen tests for COVID-19.  Conducted in October 2020, the enrollment-weighted survey data includes 22 responses from plans representing 76% of commercial enrollment of AHIP member plans.

AHIP conducted an initial survey of out-of-network COVID-19 testing costs in July 2020.  Those results can be found here.

From ensuring access to testing, to expanding health delivery capacity, to taking action to mitigate the economic and societal impact, health insurance providers are delivering solutions to the COVID-19 crisis.  Click here to view the study results and AHIP’s recommendations on how this price gouging can be stopped.


About AHIP

AHIP is the national association whose members provide coverage for health care and related services to hundreds of millions of Americans every day. Through these offerings, we improve and protect the health and financial security of consumers, families, businesses, communities and the nation. We are committed to market-based solutions and public-private partnerships that improve affordability, value, access, and well-being for consumers. Visit www.ahip.org for more information.

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