Job layoffs and slashed hours because of coronavirus threaten to leave millions of Americans uninsured. Most Americans get insurance through their employers, which adds a double-whammy to the sting of job losses.
And as COVID-19 proves highly infectious, even those with coverage are wondering what the costs of treatment might be, how much testing will cost, and whether their plan will cover these expenses.
The policy landscape is changing quickly, but here's the latest on how to make sure coronavirus costs are covered under your plan. If you need to replace or upgrade your project, you may have some options available.
Congress just passed a law requiring most private health plans to cover coronavirus testing for free. It also requires health plans regulated by the Affordable Care Act (ACA) to waive prior authorization for tests.
Although testing is covered, cost shares may apply for COVID-19 treatment if you find yourself in the hospital. The good news: Many insurers are expanding their coverage of coronavirus care.
Aetna announced they would not charge if you're hospitalized in-network with coronavirus, given you have an employer-based plan. Cigna, Blue Cross, and others have expanded their coverage as well.
To be safe, HealthCare.gov recommends checking with your insurance provider to make sure you don't have unexpected gaps in coverage.
Clinics and hospitals nationwide are turning to telehealth services to stop the spread of coronavirus into healthcare settings. Plans vary, but many providers now cover telehealth visits on the same terms as a regular office visit.
Do watch out for surprise out-of-network charges on COVID-19 office visits or treatment. If possible, use an in-network facility.
Sudden life changes due to coronavirus, like a layoff or illness, can leave your head spinning. But even if there's financial disruption, this is a risky time to "go bare" with no insurance. A 6-day hospital stay for coronavirus with no insurance could cost you a jaw-dropping $73,000 depending on the treatment.
If you have a short-term health plan, you may not be fully covered for coronavirus treatment, so consider boosting your coverage.
Here is some guidance on hunting for insurance on the healthcare marketplaces, extending your current policy through Cobra laws, or beefing up coverage during the pandemic.
If you're laid off and want to stick with your existing health plan, you can keep it for up to 18 months under the federal COBRA law (Consolidated Omnibus Budget Reconciliation Act.) The downside: your employer won't cover their share of the premium until you're working again. This may still be the best option if:
You can afford the coverage and have a chronic condition, so you prefer your current plan.
Your employer is willing to kick in some funds until you're working again, especially if the layoff is temporary.
The Affordable Care Act (ACA) was designed as a safety net for people without insurance in times of health crisis or job loss. Many Americans are facing both issues right now because of COVID-19. That makes the marketplace a timely resource.
Healthcare broker sites such as PolicyScout have noticed a sharp uptick in the number of people asking for help to pick a marketplace policy. Open enrollment for the marketplaces is usually limited to the fall unless there are unique life circumstances. Losing your job-based insurance is one of those circumstances. If the worst happens, you can usually enroll in marketplace insurance right away.
Many states have also re-opened their healthcare marketplaces because of a record 3.3 million unemployment claims in just one recent week.
Led by Washington State, the earliest virus hot-spot, these states have re-opened their marketplaces as of the end of March: California, Colorado, Connecticut, Maryland, Massachusetts, Minnesota, Nevada, New York, Rhode Island, Vermont, and Washington. The federal government is also considering whether to relaunch HealthCare.gov.
If you've lost your income, you'll probably qualify for Medicaid in the states that have expanded the program. There is an income cutoff: You'll likely be eligible if your income is below $1,400 monthly for a single person or $2,950 monthly for a family of four.
Whether you're on Medicaid or Medicare, the cost of coronavirus tests is generally covered. It's always good to double-check your policy to find out what's covered under the umbrella of coronavirus treatment, though.
Many insurers are voluntarily providing better coverage for those with coronavirus. If you still think your plan is too skimpy, ask these questions:
Which coronavirus treatments are covered?
Are there deductibles or cost-sharing fees?
Does it matter if the providers are in-network?
Do you need prior authorization for treatment, and under what circumstances?
If you're not satisfied with the answers, now's the time to change or upgrade your private plan. You might also switch to a marketplace plan if enrollment's open in your state.
If you think you qualify for a better ACA subsidy because of a loss of income, you can go to the marketplace and make adjustments. You may need to prove the income loss by providing a copy of a paycheck or termination letter.
If you're facing fewer hours at work and less income, coverage on the marketplace is based on a sliding scale. There are subsidies available and different cost-sharing plans to choose from.
Healthcare changes are happening so fast; it can be bewildering. But worrying about health, not health policy, should be your main priority right now. In these complex times, PolicyScout is an excellent choice to help you navigate the healthcare marketplaces and private plans. You can compare plans and what they cover with just a few easy clicks, or consult with an expert over the phone. Peace of mind is priceless these days, and we're here to help.