COVID-19 and health insurance: Everything you need to know
Right now, many Americans are practicing social distancing to help “flatten the curve” of the transmission of coronavirus. But at the same time, they are also seeking information on what to do should they contract COVID-19.
If you are concerned you may have COVID-19, here’s what to know about how your insurance works when it comes to testing in light of the expanded Centers for Disease Control (CDC) testing guidelines. And if you’ve lost your employer-sponsored health insurance, grab our guide to all of your health insurance options.
If you don’t have health insurance, enter your zip code below to search for plans and prices and to see if you qualify for financial help.
Does insurance cover testing and treatment?
Per the CDC, testing for coronavirus—the novel virus that causes COVID-19—is now available in all 50 states. There are currently a total of 75,000 lab kits “cumulatively” available for public labs and more are hoped to be available soon. Private companies like Lab Corp and Quest Diagnostics will be providing the majority of testing, though. And many Americans may be wondering what this means in terms of what their insurance may cover.
The Trump administration has announced that testing for COVID-19 has been designated as an Essential Health Benefit (EHB), meaning that testing must be covered by all ACA- compliant plans. This means if you are enrolled in a Marketplace plan, your insurance company will cover COVID-19 testing.
COVID-19 testing is also covered by Medicare and in most cases by Medicaid.
If you have coverage through an employer, whether COVID-19 testing is covered depends on the size of your employer. If you are employed by a company with fewer than 50 full time employees, COVID-19 testing will in most cases be covered. If you are employed by a larger company, whether COVID-19 testing is covered is determined by your employer; you should contact your benefits department for more information.
In addition, many health insurance companies have announced that the test will come with a $0 co-pay, at no cost to the patient.
You can check this list being maintained and updated by the official member organization of the insurance industry to see how your insurance company is handling fees associated with coronavirus testing.
Many insurance plans will also be covering telemedicine services should Americans wish to speak with a doctor at home through web-based conferencing, thus allowing them to continue to socially distance. Contact your health plan to learn about their telemedicine options.
Any treatment you need for COVID-19 will be covered by your insurance in the same way as any other similar treatment or hospitalization, although some insurance companies are waiving certain copays you may have to pay for COVID-19 treatment. Once again, you can consult this list from America’s Health Insurance Plans (AHIP) to learn more about the details of coverage.
Depending on the type of plan you have, the kind of coverage it provides, and your specific insurance carrier, the specifics of cost-sharing and benefits can vary when it comes to costs you may need to incur as a result of testing and treatment. Important to keep in mind is that while co-pays may be waived or COVID-19 testing, this may not apply for all other tests, treatments, or doctor’s visits associated with the virus, including hospitalization. Which means depending on the kind of health insurance plan you have, you may need to meet your deductible before full coverage kicks in for your treatment, including whatever benefits you may have for in-patient hospital care.
What are the risks of being uninsured during the coronavirus outbreak?
If you are uninsured, then you will need to pay for the cost of coronavirus testing and any treatment associated with COVID-19 yourself. The out-of-pocket costs for testing without insurance can range from approximately $500 at a doctor’s office to approximately $1000+ in a hospital setting.
In 2018, 27.9 million nonelderly Americans were uninsured in the United States. Most uninsured people are in low-income families, with families of color disproportionately represented among uninsured Americans.
Can I still get health insurance?
To talk through your options, call us at (872) 228-2549.
Outside of Open Enrollment, you can typically only enroll in health coverage if you have a qualifying life event—for example, losing your health coverage within the last 60 days.
However, many states—currently California, Colorado, Connecticut, DC, Massachusetts, Maryland, Minnesota, Nevada, New York, Rhode Island, Vermont, and Washington—have opened up Special Enrollment Periods to help people without health coverage get insured during the coronavirus pandemic.
If you don’t live in one of these states, you can check if you have a qualifying life event using our tool.
If you are currently uninsured, don’t forget that you can apply to see if you or anyone in your family may qualify for Medicaid or CHIP at any time—you don’t need a qualifying event to apply.
How does ACA insurance compare to short-term insurance during the coronavirus outbreak?
While coronavirus testing is now an Essential Health Benefit (EHB) and thus qualified for no co-pay coverage, EHBs only apply to ACA-regulated plans. Which means that EHBs do not apply to short-term health insurance.
Short-term plans typically do not cover pre-existing conditions, preventive care, emergency services, mental health care, prescription drugs and maternity care. If you have a short-term health insurance plan, know that you may need to pay out-of-pocket for any coronavirus testing or coronavirus-related hospitalization you may need for treatment.
Only plans that are regulated by the Affordable Care Act, such as those available on the Health Insurance Marketplace, contain no-cost Essential Health Benefits.
You can see Marketplace plans and prices here.
Can I apply for Medicaid or CHIP?
You can apply for Medicaid or CHIP year-round. You don’t need a qualifying event.
What is Medicaid?
Medicaid is a program jointly funded by the federal government and the states to provide health insurance to low-income Americans. Medicaid eligibility is determined based on income level. Adults, children, pregnant women, the elderly, and people with disabilities can all become Medicaid recipients. Medicaid covers one in four children, 21 percent of all low-income adults, and 60 percent of nursing home residents in the United States at this time.
While details of Medicaid programs and benefits vary by states, federal law does require that all Medicaid programs cover a certain set of “mandatory benefits.” These include inpatient and outpatient hospital services, nursing facility services, home health services, physician services, and laboratory and x-ray services.
Grab our guide to Medicaid and CHIP to refer back to later.
What is CHIP?
The Children’s Health Insurance Program (CHIP) provides low-cost health insurance to children up to age 19 to children whose families earn too much to qualify for Medicaid in their state, but do not earn enough to be able to afford private insurance. In some states, CHIP also covers pregnant women. Every state runs and offers their own CHIP insurance program for children.
While you can apply for CHIP at any time, and do not have to wait for the annual Open Enrollment Period (OEP), in 15 states, children may have to be uninsured for up to 90 days before becoming eligible to enroll in CHIP.
Each state has different guidelines in terms of income eligibility and eligibility standards. 46 states plus the District of Columbia make CHIP eligible for children whose families earn up to or above 200% of the Federal Poverty Level (FPL). That translates to $50,200 for a family of four. 24 of these states offer CHIP eligibility to children in families who earn 250% or more of the Federal Poverty Level, or $64,750 for a family of four.
While details of CHIP benefits vary slightly by state, federal law guarantees that CHIP programs everywhere must provide comprehensive coverage, including:
- Routine check-ups
- Immunizations
- Doctor visits
- Prescriptions
- Dental and vision care
- Inpatient and outpatient hospital care
- Laboratory and x-ray services
- Emergency services
What should I do if I’m experiencing symptoms?
The CDC recommends that if you are experiencing symptoms of fever, cough, and/or shortness of breath/difficulty breathing, please call your doctor immediately before visiting the office. If you are experiencing a medical emergency, you should still go to the ER.
If you are not feeling any symptoms, practice social distancing, which means staying at home as much as possible and avoiding public gatherings and events. You should also wash your hands regularly and avoid touching your face.
I am having economic difficulties due to COVID-19. Are there any benefits I’m eligible for?
Learn more about:
- 10 government programs for low income families
- Unemployment
- SNAP (also known as food stamps)
- WIC (a program for women, infants, and children)
- Medicaid (free or very low-cost health insurance)
Grab our guide to finding a free or low-cost clinic near you.
You can also see if you’re eligible for Medicaid or a subsidized Marketplace health insurance plan by entering your zip code below.
My roommate is 62 years old been sick for pastcmonth or two he wont go yo dr. He puts it of he is getting bad and i have a 6 month old baby in home as well so how do i go about him getting tested its bad
Tiffany that sounds so scary. It’s July now did you convince him to get tested? How are you and the baby doing?
At least try to convince him to get tested and try to get him to get vaccinated and I highly suggest the Pfizer vaccine 2 shot series for you both. If he can tolerate a mask in the house at all times till he is tested and vaccinated then you don’t have to wear one unless in direct contact with him. Keep isolated from your baby and if his symptoms get worse before you can do the above. CALL 911 and request an Amulance and they will most likely ensure to get him to a local ER for testing and treatment. When he is better he will thank you later.
Mark
When will we know when other states have opened up a special enrollment period. Especially interested in Florida and Georgia
Florida and Georgia use the federal marketplace, so they will only have a special enrollment period (SEP) if the Centers for Medicare and Medicaid Services (CMS) announce it. But if you’ve lost your health insurance, moved, had a child, gotten married, or had another Qualifying Life Event, you can enroll now. Give us a call at 855.772.2663 for help.
If CMS announces an SEP, we’ll definitely update this post. You can also sign up for updates with the sign-up in this post if you want to get an email if they announce an SEP.
My son had emergency surgery and due to covid there was a delay in the medicaid date and somehow its showing that when he had insurance it didn’t cover his surgery ny 30 days. Who do I contact to get assistance to cover the 4000 bill in which he had medicaid but with the delay it was not covered
You’ll have to contact your state Medicaid office.
Couldnt get verified
Hi Lisa, give us a call at 855.772.2663 to get enrolled in insurance.
How can we advocate to get PA on the list for Special Enrollment Periods?
Pennsylvania uses the federal marketplace, so they will only have a special enrollment period (SEP) if the Centers for Medicare and Medicaid Services (CMS) announce it. But if you’ve lost your health insurance, moved, had a child, gotten married, or had another Qualifying Life Event, you can enroll now. Give us a call at 855.772.2663 for help.
If CMS announces an SEP, we’ll definitely update this post. You can also sign up for updates with the sign-up in this post if you want to get an email if/when they announce an SEP.
What about NC and SEP status?
North Carolina uses the federal marketplace, so they will only have a special enrollment period (SEP) if the Centers for Medicare and Medicaid Services (CMS) announce it. But if you’ve lost your health insurance, moved, had a child, gotten married, or had another Qualifying Life Event, you can enroll now. Give us a call at 855.772.2663 for help.
If CMS announces an SEP, we’ll definitely update this post. You can also sign up for updates with the sign-up in this post if you want to get an email if they announce an SEP.
HealthSherpa is a free website and team of real people who can help you find, enroll in, and make the best use of your marketplace health insurance. Quickly see what kinds of savings you qualify for under the Affordable Care Act without ever having to sign up.
I am an employee at a temp agency but got laid off due to Covid. I’ve only been working for about a month. Usually the payments for my medical insurance gets deducted from my check. What happens now that I am not working will I still have medical insurance?
If you were laid off, you will not get health insurance from your employer anymore. Give us a call at 855.772.2663 to get enrolled.
Do I still get that check I don’t do taxes or anything I’m disabled
So what do I do what I sure can use it
The IRS will be releasing a tool on April 17 to help you – more info here: https://www.businessinsider.com/personal-finance/how-to-get-stimulus-check-no-tax-refund-direct-deposit-2020-4
If you need health insurance, give us a call at 855.772.2663
My refund was stolen and after I received my stimulus, but will and I repeat will be given back. And I honestly secondguess this app.
What if you wanna be tested to see if you have already had covid19
You’ll have to check with your insurer to see if they cover COVID-19 antibody testing. A lot of insurers do cover it! But it also depends on testing availability in your area.
Then go get tested!!.《WHY WAIT》… There are many..*I repeat* many FREE sites you can drive up.(stay in your car) and get tested
Not in Collier county florida
How about florida
All ACA-compliant insurance must cover COVID-19 testing and treatment, including insurance in Florida.
How about medicare in florida
Medicare must cover COVID-19 treatment and testing.
I’m on Medicaid currently and disability , I’m 63yrs old with diabetes and stage 3 kidney disease, and was told I could get dual coverage ,Medicaid/Medicare in one policy ?
If you’ve had SSDI for 24 months, you will automatically get Medicare.
To Darrell J Miklos:
I also have both Medicare/Medicaid and just started in January on United Healthcare Dual Complete. It covers much more than just regular medicare/medicaid from rx’s and glasses and dentist costs up to around $3,500.00. Easiest to look online at UnitedHealthcare Dual Complete. Hope you have good luck!
I’ve had the coronavirus along with a few infections without knowing for a few months and had to have emergency head surgery as a result in January ,so now I have lots of medical bills and have applied for medicaid and disability because I can’t work and couldn’t afford the job insurance but I’m having a hard time getting them to approve me, I don’t know what to do
I had breathing problems and gasping for air next thing my daughter dad and step mom said we just got tested u need to take ur mom granite she got covid 19 well she took me keaau urgent care I got swabed for covid 19 her dad and step mom had pretty much every thing I didn’t catch it bad like they had it mines thank God was only gasping for air shortness of breaths when I walk around at home I thank the board of health for doing an awesome job in helping the 3 of us they even went shopping for us with everything thank you BOARD OF HEALT H
I’m 61 years old and I have been disabled for a long time. I’m on SSI and I have Medicaid in Michigan. I’m so curious to know how to get Medicaid and Medicare for when I turn 65 because I don’t get enough money to pay for anything!
We can help you enroll here once you’re close to 65: https://www.healthsherpa.com/medicare