Although most Americans diagnosed with COVID-19 are able to recover at home, treatment for the roughly 15% of patients who require hospitalization can be exorbitantly expensive. And while many insurers are helping people pay for coronavirus-related costs, figuring exactly what is covered — and what isn’t — can be confusing.
Here’s what you can expect from your health insurer if you need testing or treatment stemming from the virus.
All comprehensive health insurance plans must pick up 100% of the cost of coronavirus testing, as well as any visit to the emergency room, doctor’s office or urgent care center that may have led to that testing. That includes any COVID-19 test deemed appropriate by the U.S. Department of Health and Human Services.
Comprehensive health plans are individual, employer-sponsored or exchange plans that meet the coverage requirements spelled out in the Affordable Care Act. If you’re insured by a short-term plan or another plan that isn’t ACA-compliant, your insurer may not cover the costs associated with your test.
Insurers must also provide free antibody testing for COVID-19 patients under the Coronavirus Aid, Relief and Economic Security (CARES) Act thatlast last month. By measuring blood for immune proteins, that someone has had a coronavirus infection and may be protected from future infections.
But health care professionals are concerned about the effectiveness of the antibody tests, how they would be administered and how patient privacy would be maintained.
Medicaid will cover the full cost of COVID-19 testing for the uninsured, as directed by the CARES Act.
Treatment co-pays and co-insurance
Dozens of insurers, including Aetna, Cigna and Humana, have waived co-payments, co-insurance and deductibles for all COVID-19 treatments. That includes hospital stays, according to America’s Health Insurance Plans, an industry trade group.
In most cases, these waivers apply only to in-network care. But some companies, such as AllWays Health Partners, will cover patient cost-sharing out of network when no in-network providers are available. This can be important in the hardest hit parts of the U.S., where coronavirus patients may be directed to certain hospitals and providers that are designated to treat COVID-19 may not be in your insurer’s network.
Some insurers also place a time limit on the waivers. For instance, Blue Cross Blue Shield is waiving cost-sharing through May, while others, such as CareFirst, are offering full coverage indefinitely. Not every insurer will cover all out-of-pocket costs from treating COVID-19. The same goes for some self-funded employer plans — even if the plan is administered by an insurer that does cover those costs in full.
With the differences in cost-sharing among plans, it makes sense to check this health insurer list or call your insurance company to find out exactly what is and isn’t covered should you or a family member need treatment for the virus.
If you find you do need COVID-19 treatment, you’ll need to keep track of what tests, medication and treatment you receive. Clearly, that’s not easy for someone who is seriously ill and kept separate from family members or otherwise isolated.
That said, a comprehensive account of the treatment you received will help when the bill arrives and you find you haven’t gotten coverage that may be mandated. Even if you’re isolated, you can sign a medical authorization form that will allow someone to talk to doctors and nurses on your behalf.
Medicare Part A and Part B, which cover hospital stays and doctor visits, respectively, will continue to charge already established co-pays and deductibles. For Part A, the deductible for a hospital stay up to 60 days is $1,408; Part B carries a $198 annual deductible.
Many original Medicare recipients also have Medicare Supplement Insurance, called Medigap, to help cover Medicare cost-sharing. Most Medigap policies should cover co-pays, deductibles and other cost sharing related to COVID-19.
If you have a Medicare Advantage plan, which is private insurance that covers Medicare Part A and Part B (and often prescription drug benefits), your COVID-19 cost-sharing will depend on your plan. Again, many insurers say they are waiving out-of-pocket expenses for coronavirus testing and treatment.
Medicare Advantage plans almost always use a network of providers to lower costs. The government now requires Medicare Advantage plans to cover out-of-network providers as long as they accept Medicare payments.
What if I’m uninsured?
The estimated cost of coronavirus-related hospitalizations for uninsured patients in the U.S. range from $14 billion to $42 billion, according to estimates from the Kaiser Family Foundation. That doesn’t include other treatment costs outside of the hospital.
Government relief efforts have allocated $100 billion in funding for hospitals and other health care providers to cover the costs of COVID-19 treatments. So far, the Trump administration has provided few details about how funding would be distributed, but the idea is that federal funds would cover the cost of treating the uninsured.
Newly unemployed patients who have lost their health insurance may find they qualify for Medicaid coverage, especially in states where the program has been expanded. In general, cost-sharing is minimal with Medicaid.
New rules for HSAs and FSAs
If you have a health savings account or flexible spending account associated with a high-deductible health care plan that allows you to pay for qualified medical expenses with pretax dollars, you now have more flexibility.
Under the CARES Act, qualified medical expenses were extended to include over-the-counter medicines, feminine hygiene products and telemedicine visits, including virtual mental health appointments.
The telemedicine provision is especially important, said Shobin Uralil, co-founder of HSA provider Lively. At a time when people aren’t venturing out to go to the doctor, virtual appointments are taking over, he said.