Coronavirus (COVID-19) & Health Insurance: Everything You Need To Know
America seems to be headed toward complete lockdown as we try to curb the spread of coronavirus but many are also seeking information on what to do should they contract COVID-19.
If you are concerned you may have COVID-19, here’s what to know about how your insurance works when it comes to testing in light of the expanded Centers for Disease Control (CDC) testing guidelines.
If you don’t have health insurance, reach out to me or a trusted local agent for help. If you lost your insurance recently, you may qualify for a Special Enrollment Period (SEP), and several states have also announced SEP's for all residents due to COVID-19.
Ryan Rundle
Health Insurance & Benefits Advisor
[email protected]
713-591-1559
Does insurance cover testing and/or treatment?
Per the CDC, testing for coronavirus—the novel virus that causes COVID-19—is now available in all 50 states. There are currently a total of 75,000 lab kits “cumulatively” available for public labs and more are hoped to be available soon. Private companies like Lab Corp and Quest Diagnostics will be providing the majority of testing, though. And many Americans may be wondering what this means in terms of what their insurance may cover.
The Trump administration has announced that testing for COVID-19 has been designated as an Essential Health Benefit (EHB), meaning that testing must be covered by all ACA- compliant plans. This means if you are enrolled in a Marketplace plan, your insurance company will cover COVID-19 testing. COVID-19 testing is also covered by Medicare and in most cases by Medicaid.
If you have coverage through an employer, whether COVID-19 testing is covered depends on the size of your employer. If you are employed by a company with fewer than 50 full-time employees, COVID-19 testing will in most cases be covered. If you are employed by a larger company, whether COVID-19 testing is covered is determined by your employer; you should contact your benefits/HR department for more information.
In addition, many health insurance companies have announced that the test will come with a $0 co-pay, at no cost to the patient. This includes most major carriers, so there's a good chance your testing will be 100% covered.
You can check this list being maintained and updated by the official member organization of the insurance industry to see how your insurance company is handling fees associated with coronavirus testing.
Many insurance plans will also be covering telemedicine services should Americans wish to speak with a doctor at home through web-based conferencing, thus allowing them to continue to socially distance. Telemedicine subscriptions are fairly inexpensive (around $25 for an entire family) and I'm happy to help set you up with one you can begin using immediately.
Any treatment you need for COVID-19 will be covered by your insurance in the same way as any other similar treatment or hospitalization, although some insurance companies are waiving certain copays you may have to pay for COVID-19 treatment. Once again, you can consult this list from America’s Health Insurance Plans (AHIP) to learn more about the details of coverage.
Depending on the type of plan you have, the kind of coverage it provides, and your specific insurance carrier, the specifics of cost-sharing and benefits can vary when it comes to costs you may incur as a result of treatment. While co-pays may be waived for COVID-19 testing (to see if one may have the virus), this is likely not the case for all other tests, treatments, or doctor’s visits associated with the virus, including hospitalization. Which means depending on the kind of health insurance plan you have, you may need to meet your deductible before full coverage kicks in for your treatment, including whatever benefits you may have for in-patient hospital care.
While co-pays may be waived for COVID-19 testing (to see if one may have the virus), this is likely not the case for all other tests, treatments, or doctor’s visits associated with the virus, including hospitalization.
What are the risks of being uninsured during the coronavirus outbreak?
If you are uninsured, then you will need to pay for the cost of coronavirus testing and any treatment associated with COVID-19 yourself. The out-of-pocket costs for testing without insurance can range from approximately $500 at a doctor’s office to approximately $1000+ in a hospital setting.
In 2018, 27.9 million nonelderly Americans were uninsured in the United States. Most uninsured people are in low-income families, with families of color disproportionately represented among uninsured Americans.
Can I still get health insurance?
To talk through your options, call me at 713-591-1559 or email me at [email protected].
Several states—currently Massachusetts, Washington, Rhode Island, New York, Nevada, and Maryland—have opened up Special Enrollment Periods to help people without health coverage get insured during the coronavirus pandemic.
California and DC also have open Special Enrollment Periods for people who did not know about their new individual mandate. You can also currently enroll in California if you did not know that there is more financial assistance available this year.
If you don’t live in one of those states, you can check if you have a qualifying life event online at www.healthcare.gov or by contacting me.
If you are currently uninsured, don’t forget that you can apply to see if you or anyone in your family may qualify for Medicaid or CHIP at any time—you don’t need a qualifying event to apply.
How does ACA insurance compare to short-term insurance during the coronavirus outbreak?
While coronavirus testing is now an Essential Health Benefit (EHB) and thus qualified for no co-pay coverage, EHBs only apply to ACA-regulated plans. Which means that EHBs do not apply to short-term health insurance.
Short-term plans typically do not cover pre-existing conditions, preventive care, emergency services, mental health care, prescription drugs and maternity care. If you have a short-term health insurance plan, know that you may need to pay out-of-pocket for any coronavirus testing or coronavirus-related hospitalization you may need for treatment.
Therefore, if you have a short-term plan you'll want to check with your carrier or agent about COVID-19 testing and treatment costs, but expect to have to pay them out of pocket.
Can I apply for Medicaid or CHIP?
You can apply for Medicaid or CHIP year-round. You don’t need a qualifying event. Contact your states Medicaid for more information.
Medicaid is a program jointly funded by the federal government and the states to provide health insurance to low-income Americans. Medicaid eligibility is determined based on income level. Adults, children, pregnant women, the elderly, and people with disabilities can all become Medicaid recipients. Medicaid covers one in four children, 21 percent of all low-income adults, and 60 percent of nursing home residents in the United States at this time.
For CHIP, Each state has different guidelines in terms of income eligibility and eligibility standards. 46 states plus the District of Columbia make CHIP eligible for children whose families earn up to or above 200% of the Federal Poverty Level (FPL). That translates to $50,200 for a family of four. 24 of these states offer CHIP eligibility to children in families who earn 250% or more of the Federal Poverty Level, or $64,750 for a family of four.
What should I do if I’m experiencing symptoms?
The CDC recommends that if you are experiencing symptoms of fever, cough, and/or shortness of breath/difficulty breathing, please call your doctor immediately before visiting the office. If you are experiencing a medical emergency, you should still go to the ER.
If you are not feeling any symptoms, practice social distancing, which means staying at home as much as possible and avoiding public gatherings and events. You should also wash your hands regularly and avoid touching your face.
If there are any other questions about Coronavirus and your Health Insurance please reach out. [email protected] | 713-591-1559
Ryan Rundle