There are hundreds of thousands of confirmed coronavirus cases in the United States right now. States like New York and New Jersey are especially hard hit, and even with signs the curve is flattening, there is still an uphill battle in many places to deal with the respiratory virus.
Everyone in the U.S. has a lot of questions about coronavirus, including questions relating to health insurance coverage and options right now.
The following are the most important things to know about health insurance during the coronavirus.
Does Private Health Insurance Cover COVID-19 Testing?
With so much of the coronavirus outbreak focused on testing, even without symptoms, Americans are looking for resources within their community where they can go to be tested for the virus. Testing is important not only if you have symptoms of the virus, but even if you don’t because you could be an asymptomatic carrier.
Under recently passed legislation, private health plans are required to cover testing for the coronavirus with no cost-sharing while we’re in this emergency period.
For states that regulate insurers, most have implemented similar requirements, and the majority of private insurance companies voluntarily expanded coverage for COVID-19 testing.
Essentially all group health plans and individual health insurance plans must cover not just COVID-19 testing but associated visits that are part of the diagnosis process for the virus.
The New Law Doesn’t Apply to Some Types of Private Coverage
There are a few caveats. The new legislation doesn’t apply to all forms of private coverage held by individuals.
For example, if someone purchased certain short-term health insurance policies, the law might not provide for coverage of COVID-19 testing. That doesn’t mean the individual insurer doesn’t offer it, though.
Health care sharing ministries are not required to follow federal standards either.
Even so, if you have these types of plans that may not be governed by the new federal laws, you are then considered uninsured in the case of COVID-19 testing. That means that you may be able to get free coronavirus testing through Medicaid coverage in your state.
The law also provides $1 billion to the National Disaster Medical System, so providers who take patients for COVID-19 diagnostics and testing when they aren’t insured can then be reimbursed.
The level of treatment someone diagnosed with COVID-19 might need can vary widely. For some people, no treatment is needed, while others may need to be hospitalized and receive intensive care.
Most private health insurance plans do cover the services that are used in the treatment of COVID-19, but they aren’t federally required to do so.
There can be variance based on state laws and individual health plans as to whether some things including telehealth and respiratory therapy visits are covered.
For someone with what is called a mini-med plan, which is a less expensive form of coverage, the coverage for COVID-19 treatments could be limited.
Since there aren’t currently any federal laws dictating limitations on cost-sharing, if you need extensive treatment for COVID-19, you could pay high out-of-pocket costs, as determined by your plan and coverage.
Can You Enroll in Health Care Coverage Right Now?
If you’re facing a lot of health anxiety, you might wonder if you can enroll in an insurance plan now, in the event you do encounter significant expenses from a COVID-19 diagnosis. Open enrollment is not open right now, so unless you qualify for the special enrollment period, then you can’t enroll in coverage through the federal marketplace.
State exchanges can, however, create their own enrollment periods, and some states may do that in response to the pandemic.
If you lose your job right now, you may be eligible to enroll through the federal marketplace through special enrollment.
What If You’re Laid Off?
Unemployment claims are soaring to record levels that we haven’t seen before in history, in response to large sections of the U.S. and world economies being shut down.
If you are laid off from your job and you lose your health insurance as a result, options are available.
If you’re laid off, and you had insurance through your employer, you may be eligible for a COBRA-qualifying plan.
With a COBRA plan, you get the same coverage you had while you were employed, but you may have to pay the full premium, so your costs are higher than when you were employed.
There is a difference between being laid off and furloughed to be aware of too. If you’re furloughed, it’s a temporary leave, and your employer is likely to maintain your benefits during this time, including your health insurance.
If you’re furloughed, you are also eligible to file an unemployment claim without it impacting your healthcare benefits.
You’ll still have to keep up with your contributions and your out-of-pocket costs if you’re furloughed.
If you aren’t furloughed but are instead let go from your job and you have a health savings account, you can use what’s in there to cover the difference in premiums through COBRA.
If you can keep the health plan that’s job-based through COBRA under federal law, you can typically stay on your employee health insurance for up to 18 months. In addition to paying the full premium, you’re also going to have to pay an administrative fee.
To determine the specifics of your COBRA options, you’ll need to talk to your employer, and if you signed up for COBRA and you’d like to switch, you may be able to move to a health plan available through the Marketplace.
If your employer goes out of business altogether, that means your health plan is going to end, so you aren’t eligible for COBRA.
Affordable Care Act Exchanges
Your better and less expensive option if you lose your job right now might be to go through an Affordable Care Act exchange. As was touched on, if you lose your job, that can qualify you for a special enrollment period.
Since you’ve lost your job and your income has gone down, you may qualify for a tax credit which can lower your premiums quite a bit.
If you go through a Marketplace enrollment, it will also help you determine if you’re eligible for something like Medicaid or the Children’s Health Insurance Plan.
If you get a Marketplace insurance plan, it takes effect on day one of the month after your employee-based insurance ends. That would mean that if you lost your job in March and you selected a plan by the end of March, you’ll get coverage starting April 1.
When you’re enrolling in a Marketplace plan, you may have to show proof you lost your job, and someone from the Marketplace might contact you if they have questions.
If you get coverage through the Marketplace and then find a new job where coverage isn’t offered, you can keep your Marketplace plan.
Applying for Medicaid
Both Medicaid and the Children’s Health Insurance Program offer low-cost or free health coverage to Americans. States set their Medicaid income limits that will determine if you are eligible or not, and the federal government urges people to apply even if they don’t think they’ll qualify based on their income.
There are no open enrollment periods for Medicaid or CHIP, so you can apply anytime.
If you have Medicaid or CHIP, you are considered covered as dictated by the health care law, and you aren’t required to pay the fee for not being covered.
While specifics of what’s covered by Medicaid vary by state, all states do provide comprehensive coverage.
Benefits that have to be covered under Medicaid include:
- Inpatient and outpatient hospital services
- Physician services
- Lab services
- Home health services
Benefits that are considered optional under Medicaid include prescription drugs and case management.
Can You Use Your IRA?
If you have an IRA and you need access to emergency funds to cover the cost of your health care, you may be able to use your IRA.
There’s something called the financial hardship withdrawal. Under this guideline, the IRS will let you take out up to $100,000 from your retirement account without paying the 10% penalty for early withdrawal.
Then, you can pay the money back for up to three years without paying taxes on your withdrawal.
During the coronavirus pandemic, you don’t need to have been laid off from your job to qualify for the withdrawal if you need to pay for health care.
You may qualify if you have experienced financial repercussions from quarantine, or you need to care for a family member as well.
The hardship guidelines don’t apply to 401(k) accounts.
Summing Up—Health Insurance and Coronavirus
The coronavirus outbreak has led a lot of people to question many things, including their health insurance coverage.
Overall, COVID-19 testing and diagnostics are pretty robustly covered under most types of insurance under federal law. However, there is more variance in the coverage of COVID-19 treatment.
What’s covered depends on your health insurance plan and your out-of-pocket or cost-sharing breakdown.
If you lose your job during this time, options include COBRA, Marketplace plans, or Medicaid, depending on your financial situation.