Coronavirus Updates and Resources
The coronavirus (COVID-19) pandemic is a rapidly evolving situation, with governments and health organizations making decisions that affect millions of lives in real time. While we’ve written about social distancing and how to keep yourself and your families safe during this time, you may have questions about how health coverage works if you are diagnosed with coronavirus. Here’s what you need to know when it comes to how your health insurance covers coronavirus – and how to get coverage if you need it.
If you have health insurance, either through an employer-sponsored plan or a Marketplace plan, you are covered for medical services and treatment as outlined in your plan’s coverage policy. In other words, there isn’t specific “coronavirus health insurance coverage,” per se. Instead, your health benefits for coronavirus medical care, like any other illness, will depend on your specific plan benefits.
Health insurance coverage for coronavirus may include services like:
In addition, many insurance carriers are expanding certain services or benefits in response to the COVID-19 pandemic. New telemedicine services may be available for doctor consultations, mental health counseling, and more to minimize the potential risk of exposure to the virus. Check if your provider covers telehealthcare.
The Trump administration has designated testing for coronavirus as an essential health benefit, meaning that insurance companies must waive copayments and deductibles for diagnostic COVID-19 testing. This means even if you have not yet met your deductible for the year, your insurance plan will cover testing for COVID-19 for free if your doctor orders the test.
As mentioned, always check with your plan first before getting a diagnostic test for COVID-19, and ask if there are provider networks or specific labs you must use to be covered. Otherwise, you could incur unexpected costs. For example, if you get tested for coronavirus in an emergency room, your insurance plan may charge you a bill for the ER visit, even if the test itself is free.
In addition, keep in mind that while insurance companies are waiving out-of-pocket expenses for diagnostic testing, you may still owe other applicable copayments, coinsurance, or deductible costs for the treatment of coronavirus. For the most accurate and up-to-date information, check with your own insurance company to find out what’s covered by your specific health plan and what your costs may be.
If you’re uninsured, costs related to coronavirus testing and treatment can be prohibitive. Diagnostic testing may range from $500 to $1,000, and for those who need inpatient hospitalization, costs can run between $75,000 to $100,000 for a 10-day period, according to a CNBC report.
If you do not currently have coverage, you may still be able to get insured even if you have coronavirus. While the Open Enrollment Period for a Marketplace plan is over, you may be able to enroll in coverage through a Special Enrollment Period if you have a qualifying life event, such as job loss, moving, or household changes. So, for example, if you had employer-based coverage and lost your job due to the current economic upheaval, you may now qualify for a Special Enrollment Period. Remember, a Marketplace plan cannot exclude you from coverage based on a pre-existing condition, including a COVID-19 diagnosis.
According to an NPR report, nearly 28 million Americans lack health insurance, and health experts fear that uninsured individuals may also be less likely to get tested or seek treatment for coronavirus because of health-care costs. In a direct response to the COVID-19 outbreak, some states have created Special Enrollment Periods for uninsured individuals. At the time of this publishing, uninsured residents in Maryland, Massachusetts, Nevada, New York, Washington, Colorado, Connecticut, and Rhode Island will be given a limited window to enroll in health coverage through some insurance companies. In California, residents who lost a job may sign up for coverage during a Special Enrollment Period that runs until June 2020. Please note that typically, California residents only qualify for a Special Enrollment Period if they lost employer-based coverage when they lost their job. However, in the newly created Special Enrollment Period, you’re eligible if you lost your job or have reduced work hours — whether or not that job provided coverage.
The general waiving of copayments and deductibles for COVID-19 testing also applies to almost all short-term insurance plans. However, short-term insurance plans are meant to provide temporary, limited coverage and do not cover pre-existing conditions. So, if you have a diagnosis of coronavirus prior to the start of your short-term plan, you will not be covered for treatment costs for that condition. Because coverage details may vary by insurance company, check with your insurance company to see exactly what your plan covers.
As another option, if you were recently laid off and had health coverage through your job, find out if your employer offers COBRA coverage, which temporarily continues your employer-based health coverage. However, please note that because premiums are paid entirely by the individual without employer contributions, premiums tend to be very high. This type of coverage is meant to be a temporary bridge until you’re able to find other coverage.
We know that it’s a difficult time, and you may have questions. If you’d like help discussing your coverage choices, we’re here to help you make sense of your options. Simply contact us at the number on this page during business hours, or send us a chat, and we’ll get right back to you.
Our mission at e-Health is to support the health and well-being of individuals and small-business. For additional coronavirus advice, health tips, and information on coverage, please visit eHealth.com
For information and guidelines specific to the coronavirus outbreak, visit cdc.gov
This article is for general information and should not be relied on as medical advice. Check with a medical professional for medical advice. Check with your particular insurance company to see what is covered by your particular insurance plan.