By: Kimberly Lankford
A STUDY BY THE KAISER Family Foundation found that the cost of inpatient hospital admissions for COVID-19 could top $20,000 – and much more if ventilator support is required. Using pneumonia experience as a guide, the analysis found that people with employer health insurance who are admitted to the hospital for COVID-19 treatment could face average out-of-pocket costs of more than $1,300. People with high-deductible health insurance policies may have to pay $2,000 or more themselves.
But new laws are expanding coverage for COVID-19 tests, and some insurers are voluntarily waiving cost-sharing for some COVID-19 treatment expenses. There are ways to reduce your costs for COVID-19 testing and care, but you need to know the rules. The following steps can help:
Federal law now requires insurers to cover the full cost of coronavirus tests and the provider visit to administer the test, whether it's at an urgent care center, emergency room or office visit. You also shouldn't have to pay any deductibles or co-payments if you go to a doctor for screening that results in a coronavirus test.
But that doesn't mean you won't get a bill. Karen Pollitz, senior fellow at the Kaiser Family Foundation, has heard from people who were charged for the test even if they have insurance. "There's no requirement that the provider can't bill you, but the insurance company has to cover it," she says. "If somebody does bill you, then you can get a receipt and submit that to your insurance company and they have to reimburse you."
There's no federal requirement for insurers to cover out-of-pocket costs that aren't related to coronavirus testing, but some are voluntarily waiving certain other charges.
"The only thing that is clear is because of the federal requirement there's no cost-sharing for testing, but the landscape is much more variable for treatment," says Sara Collins, vice president for health care coverage and access at The Commonwealth Fund. "In general, your current co-pays and deductibles will apply to any treatment you get. But some insurers are offering to cover treatment without cost-sharing, so it has to be extremely confusing for consumers to understand what cost-sharing they would be responsible for.
The details vary by insurer. For example, Cigna is waiving cost-sharing and co-payments for COVID-19 treatment through May 31, 2020. Some Blue Cross/Blue Shield plans are waiving co-pays, deductibles and coinsurance for COVID-19 medical treatment through June 30. Ask your insurer about its rules, and keep up with any changes. The Association of Health Insurance Plans has a frequently updated list of insurers' special coverage for COVID-19 costs.
Insurers (and Medicare) have been expanding coverage for telehealth – both to prescreen people for coronavirus tests, as well as to meet with doctors for other health issues without having to leave their homes. Telehealth should be covered with no cost-sharing if a coronavirus test ends up being ordered, and some insurers are waiving cost-sharing for other telehealth visits, at least temporarily.
Even if you have a co-payment or have to pay the full cost before you reach your deductible, using telehealth costs a lot less than in-person visits for minor health issues. The national median cost for a video-based virtual visit is $50, compared to $85 for low-severity treatment at a doctor's office, $130 for an urgent care facility visit and $740 for an emergency room visit, according to UnitedHealthcare.
The Kaiser Family Foundation study found that nearly 1 in 5 patients who go to an in-network hospital for pneumonia with major complications face at least one surprise medical bill. This could also be a problem for COVID-19 treatment – for example, you may be billed for a chest X-ray from a radiologist who works at an in-network hospital but isn't in your insurer's network, says Pollitz. Your insurer may pay a limited amount for the out-of-network care, and then the provider bills you for the extra charges, a practice called "balance billing."
Several states have passed laws to protect patients from surprise medical bills, such as by prohibiting providers from sending these extra bills or offering an arbitration process. But sometimes providers send a balance bill even if you aren't required to pay it. "If you get a bill that you think insurance should have paid, call the insurance company," says Pollitz. "You have appeal rights." Find out about your state's protections – you can find links to your state insurance department through the National Association of Insurance Commissioners' map.
If you lose your job, you usually lose your employer's health insurance, too. But there are several ways stay covered. If your employer has 20 or more employees, you can continue your employer's coverage for up to 18 months after you lose your job under a federal law called COBRA (most states have similar laws for smaller employers, too). You'll be able to keep the same coverage and provider network but your premiums will increase – you'll have to pay both the employer's and the employee's share of premiums (most employers pay about 75% of the premiums for their current employees).
Or you can get individual coverage through Healthcare.gov or your state's insurance marketplace. You have a 60-day special enrollment period after losing your employer coverage to sign up for an individual policy. (Several states are also creating a temporary open enrollment period for people who didn't have coverage.) You may have a different provider network, and you'll have to start the deductible period again. But you may qualify for a subsidy to help pay the premiums, depending on your 2020 income and the number of people in your household.
For example, single people can qualify for a subsidy if their income for the year is less than $49,960, or less than $67,640 for couples, or $103,000 for a family of four. It can be difficult to estimate your income for the year, so you could receive a subsidy now but may have to pay some of it back when you file your tax return if your income increases by the end of the year. Go to Healthcare.gov for calculators to help you estimate your subsidy or for links to your state's marketplace.
If your spouse has employer coverage, you may be able to be added as a dependent after you lose your employer's coverage.
Another option: Depending on your income and your state, you may qualify for Medicaid, says Pollitz. Eligibility is based on your monthly income, so you could qualify even if your income was much higher at the beginning of the year. You can find more information at your state marketplace or state Medicaid office – see Medicaid.gov. "Chances are there's an option out there you can afford, but it may not be something you're used to," says Pollitz, who recommends working with local health care navigators for help assessing your coverage options. "They will help point you in the direction and let you know about your coverage options and how to sign up," she says. Go to the "find local help" button at Healthcare.gov to find assisters in your area.
You can enroll in Medicare starting the three months before to three months after the month you turn 65. The Social Security field offices are closed because of the coronavirus, but you can enroll online at the Social Security website even if you don't plan to sign up for Social Security yet.
If you signed up for Medicare Part A when you turned 65 but hadn't signed up for Part B because you were working, you have up to eight months after you leave your job and lose that coverage to add Medicare Part B without a late-enrollment penalty. You can't sign up online because you'll need to submit forms proving that you had employer coverage, but you can mail in the forms (keep copies showing the application date). It may take a while for your evidence of coverage to arrive, especially with current delays, says Tatiana Fassieux, education and training specialist for California Health Advocates and a counselor with the state health insurance assistance program, or SHIP. She recently helped a woman who was already covered by Part A and had submitted the forms to enroll in Part B but hadn't received the evidence of coverage yet and needed a coronavirus test. "I said if you need medical care, go and get it, don't worry about the costs, and we know based on all of the evidence that we've been getting that there would be no cost-sharing," says Fassieux. You can get help with Medicare from your local SHIP – see shiptacenter.org for links.
If you do have to pay out-of-pocket costs for coronavirus expenses (or for any other eligible medical expenses) you can use tax-free money from a flexible spending account or a health savings account. If your employer offers an FSA, you usually need to use the money you contribute by the end of the year (or some let you roll over $500 to the next year or give you until March 15 to use the money). With an HSA, you can use the money tax-free for out-of-pocket costs and other eligible medical expenses anytime – even years in the future.
And if you had an HSA-eligible health insurance policy in 2019, with a deductible of at least $1,350 for single coverage or $2,700 for family coverage, you still have until July 15, 2020, to make tax-deductible contributions to your account. You can contribute up to $3,500 to the HSA if you had single coverage or up to $7,000 for family coverage, plus $1,000 if you were 55 or older in 2019 – giving you an extra tax break now, and tax-free money to use for medical expenses anytime.