With the growing infections from the SARS-COV-2 coronavirus and extended lockdowns across U.S. states, individuals and families have been struggling with both health and economic concerns. Unemployment numbers continue to rise and loss of employer coverage for those who had it is snowballing the pandemic’s impact.
Here is some information on testing, treatment, and insurance coverage that could be a good resource. Remember that with continued policy changes, some of this information may not be the most current.
Testing and Treatment Costs for Those Who Have Some Form of Insurance
The Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief, and Economic Security (CARES) Act together ensure that private health plans cover coronavirus testing and related visits to the emergency room, doctor’s office, or an urgent care center without any patient cost-sharing. This includes testing at out-of-network (OON) clinics—patients have to submit a claim with their insurance if they use an OON facility. Neither law has provisions, however, to prevent OON providers from surprise billing, where patients are billed to pay the difference in cost between list price and what their insurance chooses to pay the testing clinic (also known as balance billing). Medicaid enrollees are eligible for full coverage for the test.
Unfortunately, individuals enrolled in a short-term plan or a plan not compliant with the Affordable Care Act (ACA) may have to pay out-of-pocket to get tested.
Karen Pollitz, senior researcher with the Kaiser Family Foundation, found a wide range in test prices: $59-$229. Additionally, there was variability in whether the clinic accepted government (Medicare/Medicaid) or private insurance plans and whether uninsured patients would be required to pay the cost of the test upfront.
A Brookings blogpost recommends that the CARES Act be modified so that OON payment for COVID-19 testing mirrors Medicare payment rates or a multiple thereof to avoid exploitation of the Act’s provisions by OON providers. The blog also suggests that testing entities be prevented from balance billing patients.
Considering that widespread and repeated testing may be required as states slowly open up over the next several months, this will be an uphill task.
A brief released by America’s Health Insurance Plans (AHIP), a trade group for private health insurance plans, states that plans will cover both testing and treatment for COVID-19 without patient cost sharing (no copay or coinsurance) and prior authorization requirements have been waived. Insurers are also paying for telehealth consultations with your doctor.
Information for your specific health plan can be found here.
Medicare will cover inpatient hospitalization when recommended by a doctor and you are in a hospital that accepts Medicare. Patient cost-sharing responsibilities include:
- $1,408 for each benefit period
- $0 coinsurance for days 1-60 for each benefit period
- $352 coinsurance per day for days 61-90 for each benefit period
- $704 coinsurance per day after day 90
Health Care Options if You Are Recently Unemployed
Many people who recently lost employment, and potentially health coverage for themselves and their family, can turn to Medicaid to seek low-cost health coverage. Those whose income has now dropped low enough for them to fall below the federal poverty level ($17,000 for an individual and $35,000 for a family of four) can immediately qualify for Medicaid, enrollment for which is open all year long.
Additionally, several states have opened up a special enrollment period for state health exchanges (Marketplace) to assist individuals who have lost health coverage due to recent unemployment:
- Washington: Washington Health Benefit Exchange till May 8
- California: Covered California till June 30
- Nevada: Nevada Health Link till May 15
- Colorado: Connect for Health Colorado till April 30
- Minnesota: MNsure
- New York: NY State of Health till April 15
- Vermont: Vermont Health Connect till May 15
- Massachusetts: Massachusetts Health Connector till May 25
- Rhode Island: HealthSource RI till April 30
- Connecticut: Access Health CT till April 17
- Maryland: Maryland Health Connection till June 15
- District of Columbia
Outside of the annual Open Enrollment Period, a qualifying life event makes you eligible for the Special Enrollment Period on HealthCare.gov. Loss of existing health coverage (job-based, individual and student plans) are one of those qualifying events. Find out more here.