Does My Health Insurance Cover COVID-19 Related Expenses?

July 7, 2020

As businesses reopen and many return to work, there are persistent concerns about contracting and spreading COVID-19. Due to the recent changes in lockdown protocol, having access to coronavirus testing and treatment is key. Though most people can self-isolate and recover at home, underlying health conditions or a particularly aggressive case could require hospitalization. In that case, costs could add up quickly. Many are wondering if coronavirus-related expenses are out-of-pocket expenses, or if insurers will cover the bill.

Network Matters

The short answer is that yes, insurers will handle COVID-19 costs. More than likely your insurance coverage has already been extended to cover coronavirus testing, treatment, and any necessary hospital stay. There is a very short list of general exclusions, one of which might be that your insurer will only cover care received from “in-network” facilities and health professionals. Some companies could choose to waive this restriction. America's Health Insurance Plans provides a very helpful listing of the COVID-19 coverage that each insurer is offering customers. But as always, for specific information it’s best to contact your insurance provider.

Spelling Out Specifics

Health insurance plans purchased privately, provided by an employer, or found on your state’s healthcare exchange that meet coverage requirements found in the Affordable Care Act (ACA) are required to cover 100% of COVID-19 testing. They will also cover any bill from a doctor’s office visit, trip to an urgent care center, or emergency room visit that was related to testing. Antibody testing is also no cost to a policy holder. Depending on the provider, copays and coinsurance deductibles could also be waived for COVID-19 treatment. Thus applies to fully insured plans and some self funded plans.

In this difficult time, it’s possible that some people are between jobs or at a point of transition. For the time being, they may have a short-term health policy or another type of plan that isn’t ACA-compliant. In that case, there is no blanket requirement for insurers to offer COVID-19 coverage – you will need to check in with your insurer for precise details.

For those who might find themselves altogether uninsured, whether from loss of employment or otherwise, the government is mandating that hospitals still test and treat if need be. The facility will then be federally reimbursed for costs incurred.

Beyond Basic Scenarios

One key point to know is that there could be a time limit on COVID-19 coverage – this will vary by company. Of course as things change with the trajectory of the virus the data could affect insurers’ decisions. So a clear answer could require communication with your insurance provider. For this and all other inquiries, the provider’s website is a good place to start. You will often find a hotline or online chat feature available if you prefer to speak with a representative.

Another key thing to remember is that current turmoil in the health industry combined with shifting requirements could result in improper billing. Keeping track of treatment, tests, and any administered medications is a way to make sure that you’re being accurately billed and that insurance is doing its part. It’s a good idea to designate an advocate who can help with this in case you do fall seriously ill – you’ll likely be in no condition to keep track. And knowing what no-cost treatments you’re entitled to beforehand can make sorting through things much easier later on.

Althans Can Help

We take our responsibility to clients seriously, especially in tough times. So if you’re concerned about whether your group plan benefits will provide for COVID-19 expenses, please reach out. We’re here for you, as we always have been. It’s our honor and privilege to help in any way we can.