What Will (And Won’t) Be Covered If You Get Coronavirus

What Will (And Won’t) Be Covered If You Get Coronavirus

As the number of cases of coronavirus climbs, we want you to feel like you have all the information you need to make the best decision for your care. The last thing you want to worry about during an emergency situation is what your insurance will and won’t cover. In many cases around the coronavirus, the government is stepping in to help provide some peace of mind. For example, the federal government passed the Families First Coronavirus Response Act on March 18, 2020 which as part of the package guarantees free coronavirus testing to all Americans.

However, we know some experiences will be more complex. We’ve outlined all your major questions around health insurance coverage during coronavirus below so you can be prepared if and when you need to find care.

Will my insurance cover the cost of the coronavirus (COVID-19) test?

On March 18, 2020 President Trump signed the Families First Coronavirus Response Act into legislation which, among other provisions, has made coronavirus testing free to all Americans. This means regardless of whether or not you have health insurance, your testing for coronavirus will be free. In addition, on April 22, 2020, the House and Senate passed an additional $484 coronavirus relief package which will provide additional funding for testing.

Will my insurance cover the cost of my treatment if I have the virus?

As testing has expanded, consumers have more questions about what will and would be covered if they needed to seek treatment for coronavirus. Fortunately, 80% of those currently diagnosed only have mild symptoms and will be able to recover without needing any special or additional treatment. However, for the 20% that develop more serious symptoms or have a higher risk of developing a complication as a result of coronavirus due to their age or a pre-existing health condition, it’s very important to understand what will be covered.

Private health insurance plans are likely to cover most services and treatments associated with complications due to coronavirus, but, unlike the cost of testing, there is no federal legislation in place to guarantee this. Peterson-KFF estimates that the average out-of-pocket costs for COVID-19 treatment could be $1,464. On March 19, 2020 a group of U.S. senators sent a letter to the CEOs of major commercial insurers asking them to end cost sharing for COVID-19 treatment, however, in the absence of any legislation, consumers will still be responsible for copays, coinsurance, or deductibles associated with COVID-19 treatment.

However, every plan is different and currently insurers are offering varying degrees of support and coverage for treatment of coronavirus. For most plans, if you are diagnosed positive for COVID-19, your standard plan benefits will kick in and you will be responsible for any out-of-pocket costs related to treatment. America’s Health Insurance Plans has also put together a comprehensive summary by insurance provider of what they have committed to covering. Some plans, such as CVS Health have said they will waive co-payments and related out-of-pocket cost-sharing for commercially insured Aetna members’ inpatient admissions related to the Coronavirus strain COVID-19.

Some insurance providers have also committed to waiving the cost of a vaccine if and when that comes to market.

What if I’m uninsured?

For the 9% of Americans that are uninsured, medical costs can be a scary and common concern for individuals without insurance. If you’re uninsured, the cost of your testing will still be covered under the Families First Coronavirus Response Act. However, if you test positive for coronavirus and need additional treatment then unfortunately any costs associated with that treatment you will be fully responsible for that cost as you would with any other illness or injury when you seek medical care.

Will my insurance cover any paid sick leave?

Leaving work when you’re sick can be a tough decision for many working Americans if your job doesn’t explicitly offer paid sick leave or if you’re one of the millions of Americans who is a contract or freelance employee. Fortunately, on March 18, 2020, the federal government passed the Families First Coronavirus Response Act, a part of which is targeted to address potential gaps in paid sick leave and expanded family and medical leave. Specifically, this legislation offers the following paid leave benefits:

  • 2 weeks of paid sick leave if you have, need to be diagnosed or are quarantined for coronavirus
  • 2 weeks paid sick leave if you are caring for a family member impacted by the above
  • 12 weeks paid sick leave if you’re caring for a child while their school is closed

However, not every American can take advantage of these benefits, those who are eligible must meet one of the following qualifications:

  • You work at a small- or mid-sized company.
  • You work for the government.
  • You have been employed with your employer for at least 30 days.
  • However, small businesses with 50 or fewer employees may be exempted if paying sick leave would cause material financial harm to the business (e.g., causing the business to go bankrupt).
  • Businesses who pay paid sick leave will be reimbursed in full within three months through a payroll tax credit.

However, this plan does both include part-time and freelancers or other self-employed individuals.

Is there any way to limit my cost of care if I have the virus?

Your doctor and any medical providers working to help you get care are the best suited individuals to determine your appropriate treatment. Depending on the severity you might be instructed to isolate at home or they may recommend additional precautions or admitting you into the hospital in extreme circumstances.

Because coronavirus is such a new virus, it’s possible that medical providers will err on the side of caution and over-testing, however if you are in the majority of individuals who present mild to no symptoms then only going to the emergency room if it’s a true emergency or you need to seek medical care will help minimize those potential out-of-pocket costs. As existing legislation continues to evolve, lawmakers have also been pushing to put additional language in coronavirus legislation that bans surprise medical billing related to coronavirus treatment.

The primary thing you can do to prevent any unnecessary costs and avoid overwhelming the healthcare system is to do your best to avoid getting sick in the first place by practicing social distancing and following the CDC’s prevention tips for avoiding infection.

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