Understand your health insurance coverage for COVID-19 treatment

Health insurance companies are taking proactive and supportive positions when it comes to COVID-19.  According to public announcements made by many of the national insurance carriers in the United States, the cost of testing for COVID-19 may be covered at 100%.

What type of treatment and services should I expect to see billed to my insurance?

All of the major insurance companies, including Medicare, have indicated they will cover the cost of testing at 100%.  This means no co-pays or coinsurance, and not applying the fees towards your deductible. LabCorp, one of the largest clinical networks in the world, may charge around $51 to provide the results of the test.  Insurance companies are scrambling now to setup their systems to accept new claim codes for the COVID-19 test.

Beyond covering the lab testing itself at 100%,  you may see variations at each insurance carrier on what and how they are covering treatment related to COVID-19.  Even within each insurance company, employer groups may decide to cover services differently.  For example, self-insured medical plans can opt-out of paying for the COVID-19 testing at 100% and require that you contribute your co-pay or coinsurance. While most probably won’t opt-out, it’s prudent to know whether your employer group is self-insured and if they plan to opt-out of covering this test at 100%.

COVID-19’s affect on the economy may trickle down into people’s pockets if they get sick and require sustained medical treatment.  You may feel that it’s not your fault you got COVID-19 and don’t want to bear the cost of treatment.  It’s not uncommon for people to have large medical plan deductibles where they have to pay upwards of $3,000, $4,000 or more before the plan starts to pay.  Given that we’re at the beginning of the calendar year, most people probably haven’t met their annual deductible yet.

While it’s financially beneficial to covered members if a health insurance plan covers the cost of testing, people may wonder how their health insurance will cover treatment if they get sick from COVID-19 and end up in the hospital or needing extensive treatment.  At this point, it appears your health insurance plan will cover such treatment the same as any other illness or diagnosis.

For a limited time, you may also see insurance carriers do the following to support customers:

    • Waive customer cost-sharing for office visits related to COVID-19 testing

    • Waive customer cost-sharing for telehealth screenings for COVID-19

    • Makes it easier for customers to be treated virtually for routine medical examinations by in-network physicians

    • Waive early 30-day refill limits on prescription drugs

    • Provide free home delivery of up to 90-day supplies for Rx maintenance medications available

    • Offer supportive resources for customers, clients and communities for managing anxiety and improving resiliency (EAP)

If you do get sick from COVID-19 and need to be out of work for an extended period of time (say more than a week), you may want to consider applying for short term disability benefits. Your employer or state-funded disability plan may pay a portion or all of your salary while out on an approved short term disability.  A COVID-19 diagnosis may require a quarantine period of 14 days which could meet the definition of a disability under your plan. Ultimately, your doctor would certify your health status for disability claims.

To learn more about what your health insurance is doing, visit their website, call them directly or contact your Human Resources/Benefits Department. Here are links to several of the major national health insurance companies and their public positions on COVID-19.

Cigna

UnitedHealthcare

Aetna

Blue Cross Blue Shield

Kaiser Permanente

Medicare

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