Everywhere you turn today you are seeing new updates about COVID-19. People are being inundated with everything from how to prevent it, to what symptoms to look for to know if you have it, to lastly the number of confirmed cases in your area, country, and world.
The one thing that you do not get from most media outlets is how does COVID-19 work with regard to your health insurance coverage. This article I'll do my best to answer some very important questions that you may have and maybe even a few that you did not even think to ask.
How is COVID-19 covered on various types of health insurance?
This questions varies greatly on what type of coverage you have. We will list some of the various coverage options that you may have and how COVID-19 is covered.
Coverage offered through your employer: These plans can vary since some employers self insure while others purchase their health plan from a major insurance company. In most cases, if your coverage is with one of the major insurance carriers, this is how you will be covered for COVID-19. Testing for COVID-19 will be covered 100%. Any treatment needed would be subject to any out of pocket costs in your plan like deductibles, co insurance, and co-pays.
Coverage through the Federal Marketplace: These plans are covering COVID-19 as follows. All testing related to COVID-19 is covered 100% by the insurance. Any treatment needed would be subject to any out of pocket costs in your plan like deductibles, co insurance, and co-pays.
Coverage with Medicare or a Medicare advantage plan: Medicare and most advantage plans are covering COVID-19 like this. All testing related to COVID-19 covered 100% by Medicare and/or Advantage plans. Any treatment needed would be subject to any out of pocket costs in your plan like deductibles, co insurance, and co-pays.
Coverage with a Short Term Medical plan: These plans are covering COVID-19 as follows. All testing related to COVID-19 is covered 100% by the insurance. Any treatment needed would be subject to any out of pocket costs in your plan like deductibles, co insurance, and co-pays.
Coverage with a Hospital Indemnity plan or what's commonly referred to as Fixed Benefit plans: These plans have a fee schedule or fixed amount they pay per service received. This means when it comes to COVID-19 they will handle this the same way. You would get the fixed amount specified by your plan for testing or treatment.
Since we started drafting this blog many things have changed when it comes to coverage of COVID-19 and your health insurance. Many carriers have announced that they are covering all treatment related to COVID-19 at 100%. Some carriers have even put a time limit on when they will cover COVID related claims of May 31, 2020 while other carriers have put no time limit on it.
Here's a pretty comprehensive article about which carriers are covering this 100%.
Telemedicine
Telemedicine is becoming more widely known and used during COVID-19. This service provides patients with the opportunity to have a telephone or video consultation with a provider, thus eliminating the need to go into their office for treatment. This has been the recommended way to seek treatment by both the CDC and FDA.
Telemedicine services are explained really well in the article below.
Most plans have been expanded to cover telemedicine services, while a lot of plans covered telemedicine already. In addition, a lot of plans have eliminated any cost sharing for telemedicine during this pandemic. It is best to check with your specific carrier to see what they are doing since coverage and rules varies by carrier and plan.
What if I have no insurance?
There are many people who go uninsured by choice. There are also many now becoming uninsured through no choice of their own. So what do you do if you find yourself uninsured? The first thing that any insurance professional would tell you is try to obtain some form of coverage. There are many options out there available that are not that expensive. A great option for people looking for coverage given our current state is a short term medical plan. If you have lost your coverage recently, you may have also have options for Cobra or marketplace coverage. However, if you find yourself in a situation where none of these options are possible, then going uninsured may be a reality for you. If so, all testing for COVID-19 is supposed to be covered 100% by the government. Even if uninsured, you can and need to be tested if you feel that you have the symptoms of COVID-19. When it comes to treatment, you will be left paying for those costs. If in a hospital you can ask if they have a charity program and if you might qualify. If in an urgent care or doctor type facility, inquire about self pay rates. In many cases, if you are able to pay up front, most providers will discount your total by a significant amount. In the end, you are the one responsible for all bills from treatment.
Can my health insurance carrier terminate my coverage if I come down with COVID-19?
The simple answer is NO. There are safeguards set up to protect consumers against being terminated from a health insurance plan due to high level of claims or a specific type of claim. What can and may happen from the COVID-19 outbreak is that premiums could increase in future renewals due to higher claims payouts from this pandemic. This is something that is yet to be seen and at this point is not able to be predicted. You will see some speculation out there about this, but at this point it is just speculation.
What happens if I can not pay my premium?
When it comes to premium payments, most plans have a 30 day grace period. This means you have 30 days from your premium due date to make that payment before your coverage is terminated. One exception is if you have marketplace coverage and receive a tax credit. With this type of coverage, you can be up to 90 days late before they terminate your coverage. However, we highly recommend against doing this because with these plans, once you becomes 30 days past due your plan becomes inactive until you catch your premium up. This means that you will not be able to fill medications or get treatment covered because when the provider verifies your insurance it will show that you are inactive.
We recommend trying to pay your premiums for your health insurance as a priority. In a pandemic, health insurance is not the thing that you want to go without. If you are still not able to pay your premium, try calling your carrier and asking if there is anything that they can do for you as well. Once a coverage is terminated due to non payment, you may not be able to get your coverage back until a later date if at all depending upon the coverage and the circumstances.