While the world continues to face the challenge of fighting the health impact of the SARS-CoV-2 coronavirus (which causes COVID-19), governments have been developing policies to support individuals—whether employed or not—and families receive adequate healthcare and time off from work to care for themselves and their loved ones. Within the $2.2 trillion relief package (CARES Act) approved by the U.S. Congress in late March, $153.5 billion are allocated to public health, which includes allocations for:
- Hospitals responding to the coronavirus ($100 billion)
- Community health centers ($1.32 billion)
- Access to diagnostics, treatments, and vaccines ($11 billion)
- CDC programs and response efforts ($4.3 billion)
- Veterans’ health care ($20 billion)
- Telehealth to extend virtual access ($200 million)
- Boost stockpiles of medicines and supplies ($16 billion)
But what’s happening on the frontlines and what are some of the challenges faced on the ground?
Medicare and Supplemental Coverage
CMS announced that:
- Medicare covers the lab test for COVID-19 with out-of-pocket (OOP) costs
- Medicare covers all medically necessary hospitalizations, including if the patient needs to be in the hospital under quarantine
- A vaccine, when available, will be covered under the Medicare Part D program
- Covered telehealth services have been expanded to have broader access from more places (including home), wider communication tools (including smartphones), for interaction with a wider range of health care providers (doctors, nurse practitioners, clinical psychologists, and licensed clinical social worker)
- Those enrolled in Medicare Advantage (MA) plans have the same benefits as above, and some MA plans offer additional telehealth benefits
According to the Kaiser Family Foundation (KFF), Medicare enrollees—one of the most vulnerable populations in the current crisis—may need supplemental coverage, such as Medicaid, employer-based insurance, or Medigap, to cover some or most of their COVID-19 treatment, and that nearly 6 million of them (adults over 65 years and younger adults with long-term disabilities) do not have this coverage. The fact that 39% of these Medicare beneficiaries without supplemental insurance earn less than $20,000 annually, they might face a significant OOP cost burden if held responsible for COVID-19–related treatment. At the least, they’d be responsible for a $1,408 deductible for inpatient care; costs would add on if the patient requires outpatient services or care in a skilled nursing facility.
The KFF report stresses that this would be in addition to medical bills that these enrollees might have been facing prior to the COVID-19 pandemic.
Emergency Paid Leave Benefits
Congress passed the Families First Coronavirus Response Act on March 18. The law provides, among other things, paid sick leave and unemployment benefits to those affected by COVID-19. All public employers and private employers with <500 employees are required to provide emergency paid sick leave:
- If an employee is unable to work or telework because he/she is under quarantine or isolation
- Has been advised to self-quarantine by a health care provider
- Is experiencing symptoms of coronavirus and is seeking a diagnosis
Pay for these individuals: Up to $511/day and $5,110 over the benefit period.
Emergency paid leave can also be used by a person who:
- Is caring for an individual who is under quarantine or isolation or has been advised by a health care provider to self-quarantine
- Is caring for their child because their school or day care are closed, or childcare is unavailable due to concerns about coronavirus
Pay for these individuals: Two-thirds of the employee’s regular pay, up to $200/day and $2,000 over the benefit period.
Duration and use of the leave: 80 hours for full-time employees and an amount equal to the average working hours over 2 weeks for part-time employees.
However, the law exempts the following employees from its benefits:
- Those who work at businesses with >500 employees, including retailer such as Amazon, Walmart, and Target as well as grocery chains
- Federal employees (for paid family leave)
- Health care providers or emergency responders
- Small businesses with less than 50 employees
These exempt categories of employees mean a significant proportion of the workforce who are deemed “essential” or whose absence could burden business operations (<50 employees) may remain vulnerable during the current COVID-19 crisis.