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.
If you don’t have health insurance, enter your zip code here (opens in new tab) to search for plans and prices below. If you lost your insurance recently, you may qualify for a Special Enrollment Period (SEP), and several states have announced SEPs for all residents due to COVID-19.
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 (opens in new tab) 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 (opens in new tab) 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 (opens in new tab) 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 (opens in new tab) 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 (opens in new tab) 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 (opens in new tab) 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 (opens in new tab) 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 855.772.2663.
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 (opens in new tab).
If you are currently uninsured, don’t forget that you can apply (opens in new tab) 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 (opens in new tab).
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.
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 benefit (opens in new tab)s.” These include inpatient and outpatient hospital services, nursing facility services, home health services, physician services, and laboratory and x-ray services.
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 (opens in new tab) that if you are experiencing symptoms (opens in new tab) 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?
You can also see if you’re eligible for Medicaid or a subsidized Marketplace health insurance plan by entering your zip code here (opens in new tab).
Disclaimer: Oscar has no control over, and assumes no responsibility for, the reliability, quality, or accuracy, of this content.
This content does not constitute medical advice and is not meant to be a substitute for professional medical advice, including diagnosis or treatment. Contact your physician with any questions you may have regarding COVID-19 or your personal health. If you are experiencing a medical emergency, dial 9-1-1 for immediate assistance.
