As more Americans are implementing social distancing practices and businesses are closing or trying to convert to curbside or delivery services, many Americans are finding themselves facing uncertainty, whether from potential illness, unemployment or both.
In this blog post, we’ll cover key information and resources to help you manage your health and finances during this challenging time, whether that’s understanding the coverage you have, or helping you find a coverage option that can provide access to COVID-19 testing.
The top things to know about coronavirus testing, treatment and health insurance coverage are:
- COVID-19 testing and treatment may not be free for the uninsured.
- If you have ACA-qualifying insurance, your costs for COVID-19 testing should be covered without cost-sharing or needing to meet your plan’s deductible. Treatment will depend on your insurer and/or whether or not your state has enacted rules or legislation.
- If you don’t have health insurance, you may be able to enroll in an ACA-qualifying plan during a coronavirus special enrollment period that some states have enacted.
- If you’ve lost your job-based coverage, you qualify for an individual 60-day special enrollment period during which you can obtain a qualifying health plan.
- Note that some states have individual mandates for health insurance even though the federal shared responsibility payment no longer applies.
- If you’re unable to afford or access ACA-qualifying coverage, you may want to consider plans with lower premiums and less coverage, like short term medical insurance.
We’ll cover all of this in more detail below, and by the end of this post you should understand what options are available to you and know what next steps to take to obtain coverage.
How Much Does it Cost to Get Tested + Treated for COVID-19?
Costs for treating COVID-19 will depend on a number of factors, including whether or not you have health insurance (and how much your policy covers), where you live, and how severe your illness is.
While we don’t yet know what treatment costs look like for COVID-19, one way to get a potential idea of the costs is to look at the costs of treating pneumonia, a possible reaction to COVID-19.
- $20,292 with major complications or comorbidities
- $13,767 with complications or comorbidities
- $9,763 without complications
COVID-19 Costs With Insurance
Since state and federal guidelines now require ACA-qualifying medical insurance policies (including both individual and group plans) to cover the costs of COVID-19 testing without cost-sharing, meeting your deductible, or other pre-authorization requirements for the duration of the federally declared emergency, there should be no cost to you for testing if you have this type of coverage.
That leaves the potential costs of treatment. Again, using the 2018 pneumonia data, a person with an employer health plan that is admitted to the hospital could face out of pocket costs exceeding $1,300.
Ultimately, many insurers will use the same guidelines to determine coverage related to the novel coronavirus as they use for other known viruses that they cover unless they’re making an exception and waiving some or all of the cost-sharing as a few insurers have indicated.
If your insurance company is not making special exceptions, that means that most of the standard rules, including rules around meeting your annual deductible before your insurance company begins paying a portion of costs, likely apply to COVID-19 treatment.
For 2019, average group deductibles were as follows:
- Individual plans: $1,655
- Family plans: $2,905
For 2020, the average unsubsidized, separate medical deductible for an ACA bronze plan is $4,683.
COVID-19 Costs Without Insurance
Without a health insurance company paying a portion of the costs, you’re responsible for all costs related to COVID-19 testing and treatment, which, as previously shown, can be high.
In addition, healthcare costs when obtaining services without insurance tend to be higher because those without insurance are charged higher rates and often end up waiting to seek care, meaning their health condition may be more critical and they often have to rely on the ER or urgent care, where again, healthcare services cost more than a standard doctor’s office visit.
Will Health Insurance Cover COVID-19 Testing + Treatment?
The answer to that question is a little complicated. First, it’s important not to conflate testing and treatment as these are two different things where your health insurance is concerned.
First, let’s look at COVID-19 testing and health insurance.
The recently signed Families First Coronavirus Response Act that went into effect March 18, 2020, requires that Medicare, Medicaid, all group health plans and individual health insurance policies cover testing and associated visits related to the diagnosis of COVID-19 during the federally-declared health emergency period.
The law specifies that these insurers waive cost-sharing for telehealth services, in-person doctor’s visits, urgent care and ER visits related to COVID-19 testing. In addition to the federal law, many states have enacted additional directions and requirements for insurers.
Independent of the federal legislation, many insurance companies also took steps to make testing more available to policyholders by waiving cost-sharing such as coinsurance and copays relating to testing. And all major health plans should cover this new virus just like they would any other virus such as the flu, pneumonia or any other illness.
There will be differences in your costs based on the type of plan you have, its coverage and the carrier. So it’s very important that you understand the benefits and out-of-pocket costs associated with your specific health plan. The best way to do that is to read and understand your policy, visit your health insurer’s website or contact your health insurance company with specific questions.
What about COVID-19 treatment?
This is where you have to be even more careful. Even if copays and cost-sharing are waived for COVID-19 testing, that may not include all tests, treatments, office visits or other medical care related to the illness. So far, neither state nor federal legislation has been passed that would require insurers to waive cost-sharing for coronavirus treatment, though that may change as this national health emergency evolves.
So when it comes to treatment, which can be expensive especially if it involves hospitalization or ICU care, it’s even more critical to understand how much of your costs your health plan will cover.
Having health insurance is a good way to get help with the potentially high costs of COVID-19 treatment. So what if you don’t have insurance?
The next section looks at this problem and offers a variety of potential solutions based on your individual situation.
No Health Insurance? What to do if You Don’t Have Coverage or Were Recently Laid off
Regardless of what you may have seen posted on social media or heard on TV in recent weeks, the fact is that people without insurance in the United States may not be eligible for free COVID-19 testing or treatment.
If you don’t have health insurance and require COVID-19 testing or treatment you can expect a medical bill for the costs of those healthcare services and you will likely be required to pay those costs.
So what should you do if you do not currently have health insurance coverage, whether you’ve been uninsured for a longer period of time or you’ve recently lost your employer-provided benefits?
The sections below outline some options that may be available to you depending on your circumstances, including:
Using a special enrollment period to obtain qualifying coverage – Remember, subsidies may be available to those that qualify. This is the most comprehensive option and probably the best option if you have a pre-existing health condition.
Enrolling in Medicaid or Medicare if you qualify.
Temporarily enrolling in a short term medical plan – This may be a good option if you don’t qualify for a subsidy for an ACA-qualifying plan, if you’re relatively healthy (no pre-existing conditions), and/or you anticipate obtaining job-based coverage soon.
Getting telemedicine to obtain affordable health screening from board-certified physicians while maintaining social distancing.
All of this can be a bit confusing and overwhelming. If you’d like to speak with an insurance agent about these options or others you’re considering, call (888) 855-6837 to get your questions answered and understand your options.
Otherwise, keep reading for more on each of these options.
Two Ways to Get Qualifying Coverage Through a Special Enrollment Period
Do you qualify for an individual special enrollment period? First, take action now as your options may become more limited as time passes. If you qualify for an individual special enrollment period due to personal life circumstances (like losing your job-based coverage after being laid off), you have a limited time from the date of the qualifying event to enroll in an ACA-qualifying plan if you wish to do so.
Can you access a state-wide special enrollment period? Currently, if you reside in a state that has opened up a general special enrollment period due to the coronavirus pandemic, depending on your state, you may have as few as a couple of weeks or up to a couple of months to enroll.
Medicare or Medicaid
Another way to access qualifying coverage may be through Medicare or Medicaid if you qualify.
Enroll in Medicaid if you qualify. Medicaid provides free or low-cost health coverage to low-income individuals, families, and children, pregnant women, the elderly and people with disabilities.
As part of the recently enacted Families First Coronavirus Response Act (signed on March 18, 2020), states have the option to expand Medicaid coverage to uninsured individuals for COVID-19 testing with 100% federal financing. The legislation also requires all Medicaid-provided COVID-19 testing and diagnostic services be provided with no cost-sharing (meaning free to the insured).
Enroll in Medicare if you become eligible over the next several months to obtain benefits for COVID-19 testing and treatment. If you’re over 65 or turning 65 in the next three months and are not receiving social security benefits, you need to sign up for Medicare Part A and Part B as you won’t get Medicare automatically. If you’re already receiving social security benefits you will automatically be enrolled in Part A and B as soon as you become eligible. Learn more about Medicare eligibility and getting started.
Medicare covers all COVID-19 related tests with no out-of-pocket costs, as well as all medically necessary hospitalizations, including if you’re diagnosed with COVID-19.
In addition, if and when a COVID-19 vaccine becomes available, Medicare Prescription Drug Plans (Part D) will cover it.
Medicare has also temporarily expanded its telehealth coverage to help enrollees gain access to doctors without having to visit a doctor’s office and potentially risk exposure to coronavirus.
Why ACA-Qualifying Major Medical Insurance?
ACA-qualifying health coverage, the plans that are available through special enrollment, is your most comprehensive coverage option in general and especially when it comes to COVID-19 testing and treatment.
The coverage and benefits levels associated with qualifying plans are even more important for you if you’re in a higher risk group because it is more likely that you’ll require hospitalization or even critical care if you:
- Are aged 65 or over
- Have a respiratory condition like chronic lung disease, moderate to severe asthma, or serious heart conditions
- Are otherwise immunocompromised due to cancer treatment, bone marrow or organ transplant, or immune deficiencies
- Have certain other underlying health conditions that are not well controlled, such as diabetes, kidney failure or liver disease
- Are pregnant
Remember, these plans:
- Include coverage for the essential health benefits
- Are guaranteed-issue, meaning you cannot be denied coverage for pre-existing conditions
- They also cover pre-existing conditions, including if you’re currently experiencing flu-like symptoms
- Are eligible for subsidies (cost-sharing reductions and premiums tax credits) if you qualify – note that unemployment compensation does count towards calculating your income and subsidy eligibility
- Do not have an annual maximum limit for essential health benefits (which includes COVID-19 testing and treatment)
- Include options like individual major medical plans, Medicare, Medicaid, CHIP, and TRICARE
- Do not base costs on your health status, just your age, tobacco use, location, plan category (metal level), and the number of people on the plan
- May have higher out-of-pocket costs – for example, the average combined deductible for an individual with an unsubsidized bronze-level plan in 2020 is $6,506
- Are only available during the annual open enrollment period, an individual special enrollment period based on a qualifying life event that you experience, or if your state has extended a special enrollment period due to COVID-19
Call (888) 855-6837 to speak with an insurance agent that can help you determine if you can enroll in an ACA plan and help you get started.
Other COVID-19 Benefits Options if You Can’t Access a Qualifying Plan
If you can’t access a comprehensive major medical plan for some reason, either due to special enrollment eligibility or cost, you may still have options to help cover the costs of coronavirus testing and/or treatment.
Short Term Medical Insurance
This may be an option if you’re healthy and are just looking for temporary coverage or if you’ve suddenly found yourself without employer benefits and want a temporary lower-premium option.
It’s important to note that short term medical plans:
- Are not available in all states
- Are not ACA-qualifying coverage, therefore you cannot get subsidies for these plans
- Are not guaranteed issue and do not cover pre-existing conditions
- Are meant to be a temporary solution, typically available for 30 to 364 days
- May have lower premiums due to benefits caps, exclusions and medical underwriting
- Provide some level of benefits for unexpected medical care from an illness or injury
- Are customizable, you can select optional coverages and the benefits level you want
- Are available year-round in most states (you don’t need an enrollment period to apply)
- Begin coverage as soon as your application is accepted and your first premium payment is made
In addition to the features and limitations mentioned above, for a limited period of time, deductibles, copays, and coinsurance for COVID-19 testing and related services, including office, ER and urgent care visits are being waived, as are pre-authorization requirements related to COVID-19 testing, on short term medical insurance policies sold through this website (the Health eDeals marketplace and Independence American Insurance Company).
See if short term health insurance is available in your area and if you qualify. It just takes a few minutes.
As the coronavirus pandemic spreads and social distancing continues to be encouraged, now may be a good time to consider enrolling in a telemedicine plan.
Telemedicine may be a good option if you have:
- No health coverage and wish to be screened by a doctor
- A health plan that doesn’t include telemedicine as a benefit
- A health plan that has high out-of-pocket costs that you’ll be responsible for should you seek in-person care
- Trouble accessing in-person care, such as if you live in a rural area or an area with overcrowded medical facilities
Telemedicine allows you to be screened remotely by a board-certified physician from your home so you can maintain social distancing and reduce the strain on already overwhelmed healthcare facilities if you’re experiencing only mild cold or flu-like symptoms.
While a remote doctor’s visit cannot diagnose you with COVID-19, they can help advise you of precautions you should take should you be infected, options for easing symptoms, and when to seek in-person medical treatment should your symptoms get worse.
Telemedicine cannot replace an in-person doctor’s visit but may be a more affordable way to get access to a healthcare professional especially for those without health insurance and who are otherwise healthy with no serious medical conditions.
Telemedicine plans are available to individuals, children, and families and start at $19.99 per month for an individual, with $0 unlimited phone or video consultations.
Plans can be canceled at any time (there is no long-term contract). Telemedicine is not insurance.
Summary + Next Steps
It’s an uncertain, ever-changing time. But one thing that IS certain is it’s important to protect yourself financially and physically when it comes to the COVID-19 disease outbreak.
We provided a lot of information relating to COVID-19 costs and health insurance coverage, including a range of options that may help cover testing and treatment depending on your individual circumstances. Those included:
- ACA-qualifying health insurance available from the federal Marketplace or your state’s Exchange
- Other qualifying coverage such as through Medicare or Medicaid
- A Non-qualifying option like short term medical coverage
- Telemedicine to help maintain social distancing if you have mild symptoms
The next steps are up to you – get more information, get a quote (and possibly apply and enroll), or speak to a health insurance agent to sort through your options by calling (888) 855-6837.