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Does health insurance cover the coronavirus? (2020)

Most health insurance plans will cover coronavirus testing and treatment. Some companies are waiving certain costs — talk to your provider about your plan.

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UPDATED: May 27, 2020

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Summary

  • Some insurance companies cover Covid-19 testing, while others have some restrictions
  • The cost of testing varies from state to state
  • Check with your insurance company ASAP to see if they cover testing

As the novel coronavirus ravages communities across the globe, many here in America are wondering how their health insurance company covers COVID-19 testing and treatment, or if it is going to be covered at all. Simply put: does health insurance cover the coronavirus?

Are they going to waive prior authorization requirements? Are they only going to pay for positive test results? What happens if I have a high deductible plan? Does my health insurance cover coronavirus treatment?

This is a confusing subject in the best of times, so it’s perfectly understandable that you’d have questions about how your insurance company will pay for coronavirus testing. In the article below we’ll explain everything you need to know about your health insurance and the coronavirus.

Do you need health insurance that covers coronavirus testing? Use our FREE comparison tool above to find great rates in your area.

What is the coronavirus, exactly?

The disease we are dealing with is specifically called COVID-19, which is part of a larger group of viruses called coronaviruses. A coronavirus is a type of virus that has crown-like spikes on its surface that allow it to attach to the cells in your body.

The world has seen exponential growth in coronavirus diagnosis as 2020 has progressed.

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COVID-19 and other coronaviruses don’t always cause serious illness. In fact, estimates suggest that a large percentage of people show few symptoms and many might not ever know they caught the virus.

Others will catch COVID-19 and end up only mildly ill, though how some people are defining mild is tricky — many people are being told by doctors they had a mild case of the virus because they required no hospitalization, even though they were incredibly sick for a week or more.

Symptoms of the coronavirus include fever, cough, aches, shortness of breath or difficulty breathing, and a sore throat. In severe cases it can cause pneumonia, kidney failure, and death.

You may be wondering who is at higher risk of severe illness from coronavirus? The elderly or other otherwise infirm people are at significant risk, but the disease is capable of killing anyone of any age.

This coronavirus, in addition to being deadly, has resulted in numerous societal effects, including a reduction in traffic and mobility, cleaner air and water, and communities coming together. As for the medical side, many health public policy advocates have informed governments on steps they need to take to slow down the spread.

A major strategy in combating the coronavirus is flattening the curve. See the chart below for how successful different countries have been with this strategy.

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Is testing for coronavirus covered by my insurance?

If you think you may have COVID-19, the first step in getting treated for coronavirus is getting tested, but there is so much confusion over the testing process and what it will cost the individual getting tested that many people are avoiding it even when they need to get tested.

It is also important to follow CDC guidelines to help prevent the spread of coronavirus.

On the question of whether or not your insurance company will pay for COVID-19 testing, the answer is that it depends. Some companies are covering the testing without question, while others are putting restrictions on what they will pay for. For example, insurance company AvMed will cover diagnostic testing for COVID-19 at no cost-sharing if it is determined that the test is needed. 

Does this mean they’ll cover it if your doctor writes you a prescription for the test? Does this mean they’ll only cover positive results because a negative result is proof the test was not necessary? How are they determining the question of need?

AvMed is just one of many insurance companies who are using this type of language when explaining their testing benefit, which means that individuals will need to contact their insurance company and get an explanation, preferably a written one, for exactly when a test will or will not be covered.

Also, it’s important to remember that COVID-19 is essentially a brand new disease, so procedures and processes within your insurance company regarding the payment for testing and treatment are likely to change over time as the virus continues to move through the community or potentially mutates into something far more (or far less) dangerous than what we are dealing with currently.

It is important to be aware also that COVID-19 fraudsters are scamming people with fake coronavirus tests or vaccines. Always go with an authoritative organization’s information like the Centers for Disease Control and Prevention. If the person on the other end of the phone line or at your front door is pressuring you, that is a sign that it is a fraud.

Is treatment for coronavirus covered by my insurance?

Health insurance plays an important role in the health care available to most Americans. Even though the cost of covering coronavirus has come at a price to the health care industry, coverage is still available.

Similar to questions about coverage for testing, the answer to this question is dependent upon your specific plan. Understanding how your benefits work in regard to coronavirus is very important, including. Here are some estimates:

Coronavirus Health Insurance Cost: Uninsured vs. Insured

Here is a data from FAIR Health on the cost to both uninsured and insured people with a possible COVID-19 diagnosis:

PROCEDURENON-INSURED/ OUT-OF-NETWORKINSURED
Get Your Rates Quote Now
CBC Blood Test$36$11
CMP Blood Test$58$16
Flu Testing: A Virus$43$16
Flu Testing: B Virus$43$16
Office Outpatient Visit: 15 Min.$149$74
Office Outpatient Visit: 25 Min.$222$110
Office Outpatient Visit: 40 Min.$327$161
Global Urgent Care Visit$239$129
ER Visit: Moderate Severity$441$169
ER Visit: High/Urgent Severity$708$280
ER Visit: High Severity & Threat$1,151$443
Source: FAIR Health/ CPT © 2018 American Medical Association (AMA)

Prior Authorization for Coronavirus Treatment

Some companies are waiving the requirement for prior authorization for coronavirus treatment, others are not. Some are waiving the requirement for in-network services only.

Others don’t offer out-of-network coverage of any kind, which means if you’re rushed to an out-of-network hospital or see an out-of-network doctor, you may be responsible for paying those costs out of pocket, even if you have active insurance coverage.

Urgent Care/Emergency Visits Due to Coronavirus

Some companies are waiving emergency room fees or covering urgent care or other visits through Telehealth systems, which is great for patients.

Telehealth services allow you to meet with a doctor virtually, which means that potential coronavirus patients can check in with their doctor without leaving their home or exposing anyone else to the virus. It also means that people who need to talk to a doctor about sore throats, ear infections, or other basic health issues can check in with their provider without having to sit in a waiting room, potentially exposing themselves to asymptomatic coronavirus carriers.

Check with your insurance company to find out if they are waiving or reducing copays for urgent care or emergency room visits.

You should also find out exactly what they will and will not cover when it comes to Telehealth or other virtual doctor appointments. Don’t assume the standards that they had before the pandemic are still in place when it comes to Telehealth — many companies are now allowing virtual visits where they didn’t before in hopes of reducing their total expenditures by preventing the spread of COVID-19.

Deductibles, Copays, and Coinsurance for Coronavirus Coverage

When it comes to deductibles, copays, and health care coinsurance, each company is doing something different. For example, AllWays Health Partners is removing cost-sharing (copayments, deductibles, or coinsurance) for testing and copayments for treatment at in-network facilities.

Not all companies are making this change, however, and some plan designs are not suited to this change. Everyone needs to check with their insurance company regarding their specific benefits, getting the current information in writing whenever possible.

Why do different insurance companies cover coronavirus in different ways?

There are several reasons different insurance companies might cover COVID-19 in different ways, including:

  • Laws/regulations – Each state will have different laws and regulations, especially regarding Medicare and Medicaid coverage.
  • Self-insured vs. commercial plans vs. Affordable Care Act – Because each plan design is different, no two plans are guaranteed to have the same coverage, even if they are both through the same insurance company.
  • Plan Levels – High deductible, PPO, HMO, and EPO plans are just a few of the types of coverage available across the country, and no two plan designs offer the same coverage or benefits. A Health Maintenance Organization, or HMO, can be particularly challenging because they usually don’t cover out-of-network care.

For those on a Medicare plan, there is good news. Medicare covers coronavirus-related needs, including no out-of-pocket cost for testing. The benefits are the same if you have a Medicare Advantage plan.

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Can a claim for coronavirus be denied?

While it isn’t pleasant to think about, the answer to this question is yes, coronavirus claims can be denied by your insurance company, just like any other claim.

This has most commonly been the case with negative test results so far, but denials can happen with anything your insurance company determines is not covered under your policy or not medically necessary.

The possibility of a denied claim is one of the reasons it’s so important to know your benefits before you need to use them. As our system currently stands, it’s the responsibility of the insured to understand the restrictions on their policy, so don’t wait to review your plan details.

What costs are there for uninsured people who get the coronavirus?

This depends entirely on where in the country you live, unfortunately. Some states are waiving costs and some are not.

The federal government has made noises about paying for some benefits, but our current administration changes their mind on these issues almost daily, so this will completely depend on when you need to make use of services and what decisions have been made at that time.

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If you are uninsured, it might be a good idea to reach out to your primary care physician (if you have one) and ask them what they want you to do in the event you catch COVID-19 and what costs you can expect to incur if you need medical care.

If I don’t have insurance right now, is it too late to sign up?

Because of the special circumstances surrounding this virus, many people are being given the opportunity to sign up for coverage even though it is not their open enrollment period.

If you’re employed by a company that offers benefits, talk to your employer about coming onto the company plan. They may have an emergency open enrollment period available.

For people who are self-employed or otherwise not able to access a plan through their employer, there may be a special enrollment period available to you through the Affordable Care Plan.

The most important thing is to look into your options immediately, because the longer you wait, the less likely it is that you’ll be able to join a plan outside of your traditional enrollment period.

I lost my job. Does COBRA cover coronavirus treatment?

If your company laid you off during this time or your coverage was provided through a spouse/parent who passed away, you have 60 days to elect COBRA coverage. You will be covered for coronavirus at the same levels as you would have been under your work plan.

However, if your company goes out of business or stops offering coverage to any of its employees, you will not have access to COBRA benefits. If this is the case, look into your state’s insurance exchange for the Affordable Care Plan available to you in your area.

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Coronavirus and Health Insurance: The Bottom Line

Insurance companies are generally covering COVID-19 testing and treatment, though you can’t know how you are specifically covered without reaching out to your insurance company.

The most important thing for you to do is gather all of your information as soon as possible. Waiting until you need treatment to find out the specifics of your coverage could cost you tens of thousands of dollars in denied claims, or worse, you could be refused medical treatment because the doctor or hospital you need does not accept your coverage.

A few minutes of research now could save you thousands of dollars, or even your life. use our FREE comparison tool today to find health insurance that covers coronavirus testing and treatment.

References

  1. https://www.mayoclinic.org/diseases-conditions/coronavirus/symptoms-causes/syc-20479963
  2. https://www.ahip.org/health-insurance-providers-respond-to-coronavirus-covid-19/
  3. https://www.cnbc.com/2020/03/09/what-you-need-to-know-about-coronavirus-and-your-health-insurance.html
  4. https://consumer.findlaw.com/insurance/insurance-laws-by-state.html
  5. https://www.medicare.gov/medicare-coronavirus
  6. https://www.nytimes.com/2020/03/03/health/coronavirus-tests-uninsured.html
  7. https://www.healthcare.gov/blog/coronavirus-marketplace-coverage/
  8. https://www.dol.gov/general/topic/health-plans/cobra

About Rachael Brennan

Rachael Brennan has been working in the insurance industry since 2006 when she began working as a licensed insurance representative for 21st Century Insurance, during which time she earned her Property and Casualty license in all 50 states. After several years she expanded her insurance expertise, earning her license in Health and AD&D insurance as well. She has worked for small health insurance exchanges as well as some of the biggest health insurance companies in the nation, including BCBS. After deciding to pursue a writing career several years ago, she has circled back to the auto insurance industry.

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