How COVID-19 is Changing Insurance Coverage

COVID-19 has upended healthcare across the globe, and the US has become the epicenter of the crisis, with more than 25% of the world's 10 million-plus cases. The number of cases has recently spiked again in a majority states after a brief period of lower numbers. Some experts believe that we are still in the first wave of the pandemic and may face a second wave in the fall. In any event, the crisis promises to continue throughout this year and well into 2021.

The US citizenry has not faced such an overwhelming challenge in many years and has struggled to adapt. This pandemic has made major changes in the way people live their lives, with many doing their jobs or going to school online from home. Facetime or ZOOM visits have replaced family get-togethers and workplace meetings. Most large social gatherings have mostly stopped, and even grocery shopping has become anxiety-producing since maintaining social distance is so difficult. Home delivery of virtually everything has exploded. Staying inside and away from others has become the norm for many.

This atmosphere has impacted every facet of the American economy, but health insurance is the industry that is undergoing some of the biggest changes. So many citizens have been affected that areas are struggling to provide necessary treatment. As a result of this medical treatment surge, the demand for more accessible and affordable healthcare policies is increasing, strongly affecting the political landscape. The US has already altered many medical insurance practices and more are on the horizon.

Telehealth Changes

Before the COVID-19 crisis, telehealth coverage was limited for Medicare, Medicaid, and private insurance patients. In some cases, policies only covered visits for rural patients with limited access to medical providers. In March, the CMS implemented temporary changes to their Medicare and Medicaid coverage that granted patients greater access to telehealth services. Named under Waiver 1135, these alterations included payment for office and hospital visits that took place in the patient's home. A variety of providers could offer these telehealth services, including doctors, nurse practitioners, clinical psychologists, etc. Providers licensed in other states could conduct telehealth visits, a major difference from pre-COVID 19 days.

These changes allowed those patients at higher risk for contracting COVID-19 to receive healthcare advice, post-procedure checks, medication consults and other services without unnecessarily exposing themselves to the virus by visiting a facility. They also benefited COVID-19 patients with mild or moderate symptoms by allowing them to avoid emergency and urgent care facilities where they could easily infect others.

Some private insurers followed the government's lead and broadened their telehealth guidelines as well. Companies such as Cigna, Anthem, Aetna, and United Healthcare made changes to their coverage that let their policyholders enjoy the advantages of telehealth during the pandemic. Of course, each company set its own terms, but many policyholder have enjoyed expanded health coverage in this area. Telehealth visits are uniquely suited to the current coronavirus crisis.

The success of telehealth visits may lead to broader coverage after the pandemic is finally over. These visits protect vulnerable populations and encourage regular communication with medical providers. Isolated or vulnerable patients will be able to get better routine care, and those people who receive preventative care are less likely to need expensive procedures and long hospitalizations in the future. Technology enhances telehealth visits since internet devices can give the provider basic information such as blood pressure and heart rate from a distance. Also, home health aides can be enlisted to help patients during their telehealth visits so that the treating provider has accurate information.

Private insurers and the CMS may well want to keep aspects of these pandemic telehealth changes permanently since patients benefit and providers can use them to enhance patient care - advantages that improve insurance company revenue.

Employer-based Insurance

Employer-based insurance has been the norm in the US since World War II. Originally, employers began enticing scarce workers by offering these benefits since they weren't allowed to outbid other companies by offering higher wages. Instead, desperate employers used non-taxable health benefits to outmaneuver their competitors. Americans realized that these benefits greatly added to their compensation and embraced this system, which was not a particularly logical way to provide health insurance. In fact, Americans are now so used to the concept that many do not question its logic. However, the COVID-19 pandemic has highlighted all the weaknesses of this system. When people lose their employment, they are extremely vulnerable to the loss of their health benefits.

During a pandemic, people need their insurance more than ever to help them pay for emergency room visits, medications and expensive procedures. Unfortunately, many people have lost their jobs as a direct result of this health crisis. In the US, the unemployment rate leaped from 3.5% in February 2020 to 11.1% In June, after reaching a high of 14.7% in April. This unemployment surge caused workers to either pay for their COBRA coverage, which is often quite high, or turn to the Healthcare Marketplace, which has seen a boom in new enrollees. Others simply ended up with no coverage at all.

People who meet a low-income threshold may qualify for Medicaid, which is both a federal and state program. The federal government contributes funds toward Medicaid, but the individual states run the programs, so the benefits vary. Fourteen states have rejected Medicaid expansion, which makes it easier for people with modest incomes above the poverty line to receive benefits. As a result, some people affected by COVID-19 have fallen through the insurance cracks and face huge medical bills as well as a grueling recovery.

Public Option and Medicare for All

The Affordable Care Act, which made healthcare insurance more accessible for many, is still under attack in the courts. A certain faction of Americans would like to see it repealed. On the other hand, many want to see more healthcare options made available to Americans. Some citizens groups are crying out for a public option or Medicare for All. These two programs are not the same thing, but they are both meant to free people from relying on employer-provided, private healthcare insurance and instead have them rely on government-operated healthcare. A public option would allow people the choice between a private or public plan while a Medicare for All plan would be mandatory. The debate over providing this type of healthcare has heated up in recent years, although there has been vocal opposition to the change.

Some industry experts feel that the COVID-19 pandemic may push more people to embrace either a public option or Medicare for All. Advocates of these plans believe they enable a move away from private, employer-provided healthcare that could result in better health coverage and lower premiums, copays, deductibles and coinsurance. Millions of people could potentially benefit and avoid thousands of dollars in medical bills. Research shows that patients without insurance who are hospitalized due to COVID-19 end up owing an average of $73,300 for a six-day stay. Patients who are ventilated and spend weeks in the hospital face even more catastrophic bills if they are not insured.

Of course, physicians and other providers might decide not to participate in a public option since any government plan will likely reimburse medical professionals at a lower rate than private companies would. Plus, there is still widespread suspicion in the US about government healthcare for all despite an overall positive view of Medicare for seniors, which is somehow viewed differently. After the 2020 election, most experts expect that the new or current administration will be enacting some major reforms, either away from the Affordable Care Act or toward more government-sponsored healthcare.

Current Options

If you have lost your job or face reduced hours, you can seek coverage from an ACA-approved policy. A change in circumstances means that you may be eligible for a special enrollment period. So, you don't have to give up on health insurance coverage even if you lose your plan in the summer or fall.

Sites such as PolicyScout can also help you to compare coverage options so you can find the benefits that you need at a price you can afford. The current pandemic is expected to last well into next year, so now is the time to research healthcare options. While having the right healthcare coverage is always important, it's even more vital today. You cannot afford to be unprotected or under-protected. The risks are simply too high.