As uncertainty continues to surround COVID-19 and its impact on care and health systems, two new thorns are beginning to dig into the conversations about healthcare’s future: costs of testing and planning for insurance rates despite the current chaos.

According to a report commissioned by America's Health Insurance Plans (AHIP), diagnostic testing for COVID-19 may creep past $25.1 billion annually. Meanwhile, antibody testing costs could touch more than $19 billion.

The study reports a wide swing in what the costs may be, mainly because of uncertainty about which type of test will be used most and the unknown level of need for testing and variability in costs per test in the future. Current prices for administering the tests are between $95 and $130 for diagnostic testing for Medicare and Medicaid and between $90 and $125 for antibody testing.

How tests are covered — as availability and need come more into focus — will likely be better determined in the coming months. However, the Coronavirus Aid, Relief, and Economic Security (CARES) Act requires insurers to cover all tests without cost-sharing. That’s only the case if deemed medically necessary by a provider.

Major payers have all waived cost-sharing for COVID-19 treatment and testing, and many have expanded telehealth reimbursement and rolled back prior authorization requirements.

AHIP said in a statement that not enough is being done to make clear the process for bringing testing to patients and how those tests are to be paid. “Testing strategies need to be part of a holistic public and occupational health strategy,” the organization said in its statement. “Federal guidance should consider funding for testing in that context, and should clearly articulate the roles of insurance providers, employers, and public health officials.

California actuaries said in March that plans in the individual marketplace could see premium rates increase by as much as 40%.

Setting premiums for the year ahead may be one of the most difficult for the industry than at any other time in the past, the American Academy of Actuaries says. It is evident to observers that COVID-19 is creating "significant uncertainty" for those payers and those attempting to project claims and plan usage. Potentially ongoing waves of the virus fuel that uncertainty.

Making matters murkier is the unemployment rate, which reached 14.7% in April, but dropped to 13.3% in May. Most Americans receive their insurance coverage from their job. These losses may affect coverage and planning and projections for the year ahead.

As patients return, patients care needs may change, particularly for those who put off cancer or other screenings. For those putting off care, their long-term costs may increase, which impacts payer costs and projections.

All of this isn’t possible without bringing in providers. Analysts suggest that they likely will pressure insurers for higher reimbursements to make up for losses.

These two issues are just a couple among many to rise up in the months ahead, but they are essential for patients, payers, and providers and impact every level of care across the spectrum.