Picwell Blog

What You Need to Know About COVID-19 and Health Insurance Coverage

May 7, 2020 1:11:31 PM / by Sam Kina


All of us are living in an increased state of uncertainty due to COVID-19. Suddenly, the prospect of falling-ill to the point of needing hospitalization no longer seems like a remote possibility for even the healthiest among us. For most of us, concern about our physical health is and should be the foremost of our concerns, but financial uncertainty about how to pay for COVID-19 related healthcare is another source of anxiety for many.  

As things stand today, May 7, 2020, what you will pay for COVID-19 related treatments may vary depending on who you get coverage from.

The highlights

  • All health insurance plans are required by law to waive all cost sharing for COVID-19 testing and any doctor visits related to COVID-19 testing and diagnosis.
  • Some, but not all, health insurance companies have waived cost sharing for COVID-19 related hospitalizations, which can lead to big differences in the price you pay if you are hospitalized due to COVID-19.
  • All insurance companies have waived cost sharing for any telemedicine visits related to COVID-19, and many insurance companies have waived cost sharing for ANY telemedicine visits.
  • 11 states plus the District of Columbia have enacted special enrollment periods that allow you to buy an ACA plan if you are currently uninsured, but if you are uninsured because you recently lost your job, you can get an ACA plan in all states.
  • If you need to pick an ACA plan, here are three things to keep in mind: 
    • Check whether the plan covers COVID-19 related hospitalizations, 
    • Check to see if the hospitals you are likely to use are in network for those insurance companies, and 
    • If you qualify for a Silver plan with cost sharing reductions, go with that. Otherwise, a Bronze plan will probably be your best value if you stick with one of the companies that have waived cost sharing for COVID-19 hospitalizations. Bonus points if that plan is HSA eligible.

What’s covered?

Pursuant to the recently passed coronavirus relief legislation, H.R. 6201, all commercial insurance companies are required to waive any cost sharing associated with COVID-19 testing and health care provider services related to diagnosis and testing.  This means that if you suspect that you might have any COVID-19 related symptoms, you won’t pay anything for any doctor’s visits for immediate diagnosis, treatment and testing.  Visits at doctors’ offices, urgent care centers and emergency rooms are all covered, but you should always consider a telemedicine visit as your first option. Pretty much everyone, from health care providers to insurers to the CDC strongly urge you to use telemedicine as your first option, especially if you suspect that you may have any COVID-19 symptoms.

To that end, all insurance companies have waived all cost sharing for telemedicine visits related to COVID-19 treatment and diagnosis, and many insurance companies are waiving telemedicine cost sharing for ANY reason. This means that you can get routine healthcare consultations from the safety of your own home, and not have to worry about copayments. 

What isn’t covered?

Unfortunately, COVID-19 related health care costs go far beyond just testing and diagnosis. While the data around COVID-19 is still uncertain, there are a few things that we do know: it is more contagious than the flu, hospitalization rates are much higher than the flu, and when you are hospitalized, the length of stay is longer.  This all adds up to mean that, compared to most years, we are all at much higher risk of a lengthy hospital stay. This can be costly, and many insurance companies have not waived cost sharing for hospitalization related to COVID-19.

Of the insurance companies that we have reviewed, Aetna, Cigna, and Humana have all clearly stated that they will waive cost sharing for any inpatient admissions related to COVID-19.  Aetna’s and Cigna’s cost sharing waivers only apply to in-network hospitals and providers. Humana has stated that it will waive all cost sharing, regardless of network status, but it cautions that out-of-network providers may still “balance-bill” patients for costs above and beyond what Humana pays to the provider. This list is subject to change over time, so if you have or are considering health insurance through another company check how they treat cost sharing for COVID-19 related hospitalizations.

A recent study by FAIR Health estimates that the cost of COVID-19 related hospitalization could average close to $40,000, and a subsequent ICU admission could drive that cost substantially higher.  If you get your health insurance from one of the companies that is waiving cost sharing for COVID-19 related hospitalizations, knowing that you aren’t on the hook for these costs can cross one very important thing off of the long list of things that we have to worry about these days.  

If your insurance provider has not waived cost sharing for COVID-19 related hospitalization, a hospitalization will result in charges at or close to the annual out-of-pocket maximum for many people. This would represent a serious financial burden for the vast majority of households, but hopefully more companies will follow the lead of Aetna, Cigna and Humana and waive cost sharing for hospitalizations.

How your insurance covers COVID-19 treatment costs may also vary depending on where you live.  Currently, the District of Columbia, Massachusetts, and New Mexico require insurance companies to waive all cost sharing for COVID-19 treatment.

Regardless of whether your insurance provider is currently covering hospital costs for COVID-19 treatments, you should make sure you know which of your local hospitals are in-network. In emergency situations, you might not have the luxury of choosing which hospital to go to, but if you are able to choose, going to an in-network hospital will help protect you against surprise medical bills.

What if I have a High Deductible Health Plan?

Even if you have a high deductible health plan (HDHP), any testing costs and doctor visits related to COVID-19 testing and diagnosis will come at no cost to you. Aetna, Cigna and Humana, have also specified that the cost of hospital admissions due to COVID-19 will be completely covered for all of their commercial plans, so this means that you don’t have to worry about high deductible payments related to COVID-19 if you are in an HDHP.

Furthermore, many health insurance plans are waiving any cost sharing for telemedicine consultations regardless of whether or not it’s related to COVID-19. This means that if you had been meaning to ask your doctor about a problem that has been nagging at you for a while, you may be able to do that through a telemedicine visit and not have to worry about your deductible. However, if you are in an HDHP, make sure to check with your insurance company to see how it is covering telemedicine.

What if I don’t have health insurance?

If you are among the millions of people who were recently laid off, you’ll need to figure out how to get health insurance.  You may have a few options.  If you previously receive health insurance through your employer, a federal law called COBRA allows you to keep your employer coverage for up to 18 months, but it comes with a catch. You have to pay the full cost of your insurance plan, which can be quite a bit more than you were used to paying when your employer was paying for a portion of your premiums.  

If COBRA coverage is unavailable or unaffordable, you may be able to get coverage through Medicaid or through an ACA plan. If you lost your job, these may be better options than COBRA. Medicaid eligibility rules vary by state, but don’t just assume that you can’t get Medicaid if you were earning a decent wage earlier in the year. Medicaid eligibility just depends on what you make in the current month, so if you are unemployed, you may be able to get coverage through your state’s Medicaid program. ACA coverage gives you another good option for coverage if you think you might not qualify for Medicaid. If you are unemployed, you’ll probably qualify for premium tax subsidies that help cover the cost of an ACA health insurance plan, and you may even be eligible for special “Cost Sharing Reduction” (CSR) plans that limit how much you pay when you go to the doctor. Even if you have a spouse who is still employed, you may qualify for ACA premium tax subsidies.

If you lost your job, that counts as a qualifying event that will allow you to pick an ACA plan even though we are outside of the annual enrollment period, but if you didn’t lose your job and just chose not to purchase any insurance during the last open enrollment period, you may still be able to buy an ACA plan. Currently, 11 states and the District of Columbia have established special enrollment periods that allow you to purchase insurance through that state’s exchange. These special enrollment periods are active in California, Colorado, Connecticut, the District of Columbia, Maryland, Massachusetts, Minnesota, Nevada, New York, Rhode Island, Vermont, and Washington.

Which ACA plan should I choose?

The best plan for you depends on a lot of things, including what your healthcare needs are, what you can afford and the cost of the different options available to you, but here are a few things that you should consider:

  • If at all possible, pick a plan from a company that has waived cost sharing for COVID-19 hospitalization.
  • If you can choose from a couple of carriers that have waived COVID-19 treatment costs, check the network status of your doctor (if you have one) and the hospitals closest to you. If possible, pick a plan where your doctor and local hospital are in-network.
  •  If you qualify for a CSR plan, that will be your best option. These plans are really great values, since you get the coverage of a much more costly plan at a fraction of the cost.
  • If you don’t qualify for a CSR plan, don’t assume that more coverage is always better. Focus on value. You might not need that Platinum plan.  If your primary concern is covering costs in the event that you get COVID-19 a Bronze plan should be just fine, especially if you go with a company that covers COVID-19 hospitalizations. Even in a Bronze plan, all your COVID-related costs will be covered, and, while you might have to pay higher cost sharing for health care that isn’t related to COVID-19, the lower premiums usually make this a worthwhile gamble.  Don’t waste money buying more insurance coverage than you really need.
  • If you do pick a Bronze plan, check whether that plan is eligible for a health savings account (HSA). Even if you think that you might not be able to afford to save money in an HSA, they are a great option to have. If you get a medical bill, you can just contribute that amount to your HSA when you get the bill, pay the bill through your HSA, and then deduct that expense from your taxes.

Conclusion

With COVID-19 increasing all of our health and financial risk, having the right health insurance coverage is more important than ever. Congress has mandated that insurance companies waive all cost sharing for testing and basic medical care for COVID-19, so, if you have health insurance, you don’t need to let cost be a barrier to getting the care you need.  If you don’t have health insurance, you may have options to get covered, and getting the right coverage can help give you peace of mind that, at the very least, you’ll have some financial protection if you do get sick.

Topics: Benefits Decision Support, Health Insurance, Consumer Directed Health

Sam Kina

Written by Sam Kina

Samuel Kina, Ph.D. is the SVP of Economics & Data Science at Picwell where he has led the company’s work in economic and predictive modeling since 2014. He has a wide range of experiences in health policy and economics and has taught courses in statistics, economics, and health policy. Prior to joining Picwell, Sam held positions at the Analysis Group, Congressional Budget Office, and the Alliance for Health Reform. Sam has a B.A. in Public Policy Analysis and Economics from Pomona College and a Ph.D. in Health Policy and Economics from Harvard University.