Most Americans who become coronavirus patients can undergo treatment at home and recover relatively easily. But about 15% of patients need hospitalization, and treatment expenses can be prohibitive. The good news is many health insurance carriers have packages that cover COVID-19 recovery costs. In this article, we analyze the options provided by health insurance providers in the U.S. for COVID-19 testing and treatment.
All comprehensive health insurance policies need to cover the entire cost of COVID-19 testing and also visits an urgent care facility, doctor’s office, or emergency room for the testing. This includes coronavirus tests sanctioned by the U.S. Department of Health and Human Services.
These comprehensive health packages are exchange, employer-sponsored, and individual policies that comply with the coverage requirements mandated by the Affordable Care Act (ACA). If you have a plan that is not compliant with the ACA or a short-term package, your provider might not cover testing costs.
As per the CARES (Coronavirus Aid, Relief and Economic Security) Act, insurance carriers should also offer free antibody tests for coronavirus patients. This test measures blood for immune proteins and indicates if an individual has previously had a COVID-19 infection and might be shielded from infections in the future. However, concerns remain about the antibody testing’s effectiveness, its administration, and the protection of patient privacy. The CARES Act directs Medicaid to cover the entire cost of coronavirus tests for uninsured individuals.
Treatment Coinsurance and Copays
Many providers, including Humana, Cigna, and Aetna, have waived deductibles, co-insurance, and co-payments for all coronavirus treatments. This waiver includes staying at a hospital for recovery as per an industry body named America’s Health Insurance Plans.
Mostly, these waivers are only for care within the network. However, some carriers like Allways Health Partners, cover out-of-network costs if there is no in-network facility available. This is an important provision in deeply hit areas in the U.S., where patients may be sent to providers and hospitals that are not in their insurance provider’s network.
Some companies have a time limit for the waivers, while others like CareFirst are providing full coverage for an indefinite time period. Not all insurance plans cover all the out-of-pocket expenses of COVID-19 treatment. This applies to self-funded employer packages as well, even if the insurer’s plan does cover full costs. Because of the differences in cost coverage, you should check with your health insurance carrier about the features they provide for coronavirus testing and treatment.
COVID-19 patients need to keep track of the tests, treatment, and medication they get. This can be a difficult task for those in isolation because of the mandatory quarantine. But it is essential to ensure your insurer covers mandatory costs and bills. If you’re in quarantine, you can authorize a family member or friend to represent your case to the medical staff.
Medicare Parts B and A, which pay for doctor visits and hospital stays, respectively, will continue the charging of established deductibles and copays. Part A’s deductible is $1,408 for a stay at a hospital for up to 60 days; For Part B, the annual deductible is $198.
A lot of Medicare beneficiaries also have Medigap supplement insurance to cover cost-sharing in Medicare. Most Medigap packages cover deductibles, co-pays, and other types of coronavirus-related cost-sharing. For those with a Medicare Advantage policy (this is a private plan that covers Medicare Parts A and B and prescription drug costs most times), coronavirus expense-sharing will depend on their package. Again a lot of insurers have decided to waive out-of-pocket costs for COVID-19 tests and treatment.
Medicare Advantage policies typically lower costs by using a provider network. Now, the government requires these packages to cover out-of-network companies as well as if they take Medicare payments.
Information for Uninsured Individuals
The Kaiser Family Foundation estimates that the cost of hospitalization for coronavirus treatment for uninsured persons can go up to $42 billion. This figure doesn’t include out-of-hospital treatment expenses. The government has allotted $100 billion for health care facilities and hospitals to cover virus treatment costs. These federal funds cover the treatment expenses of uninsured people.
Patients who have lost their jobs and health insurance can qualify to get Medicaid coverage, especially if they live in states that have expanded this program. In general, Medicaid minimizes cost-sharing.
Ideally, business owners should invest in benefits administration-integrated HRIS and Payroll Software to make their HR management more efficient and deliver the needed benefits including health insurance to their employees. Check with your company if their employer-funded health insurance plan covers COVID-19 testing and treatment costs.