Will my health insurance cover the costs of coronavirus testing and treatment?

Will my health insurance cover the costs of coronavirus testing and treatment?

In general, comprehensive major medical health plans will cover COVID treatment and lab-based testing, albeit with the plan’s regular cost-sharing (deductible, copays, coinsurance).

During the COVID public health emergency, most plans were required to cover the full cost of testing, including lab-based and at-home testing. But that’s no longer the case. So coverage of at-home COVID tests is now optional for health plans other than Medicaid.

How will my health plan cover a COVID-19 vaccine?

The CARES Act (H.R.748, enacted in March 2020) requires all non-grandfathered health plans, including private insurance, Medicare, and Medicaid, to cover COVID-19 vaccines without any cost-sharing for the member (plans that aren’t regulated by the ACA — such as short-term health plans or fixed-indemnity plans — are not included in the vaccine coverage requirement).

This requirement did not end with the public health emergency, so ongoing full coverage of recommended COVID vaccines is the same as the coverage rules for other vaccines recommended by the CDC.

How can the uninsured get COVID-19 testing and vaccines?

HHS has a resource page about COVID-related care for people who don’t have health insurance. It includes details about obtaining zero-cost vaccines, and low-cost or zero-cost testing.

How much of COVID treatment costs will health plans cover?

This depends on the details of the specific plan. Although comprehensive major medical plans will generally cover all medically necessary inpatient and outpatient care that someone receives for COVID (or long COVID), “cover” doesn’t mean they’ll pay for all of it.

How do I make sure I have coverage to protect myself from COVID?

So what can you do to protect yourself as much as possible in terms of your health insurance coverage? Here are a few pointers:

• If you’re uninsured (which includes having a health plan that’s not minimum essential coverage), you can enroll in a plan through the health insurance marketplace (exchange) in your state during open enrollment, which runs from November 1 to January 15 in most states. You can also enroll if you have a qualifying life event. (Note that some special enrollment periods are ongoing or much longer than normal, including the low-income special enrollment period, special enrollment period for American Indians and Alaska Natives, and the loss-of-Medicaid special enrollment period in many states.)
• Enrolling in coverage through the exchange is an excellent opportunity to take advantage of the enhanced premium subsidies created by the American Rescue Plan/Inflation Reduction Act.
• If your income is low (even temporarily, due to a layoff), check to see if you might be eligible for Medicaid.
• If you have health insurance, make sure you understand what your plan covers and what your cost-sharing responsibilities are for various outpatient and inpatient care.
• Check to see how your health plan handles prior authorizations.
• Pay attention to the details of your health plan’s provider network. Your best chance of avoiding balance billing is to make sure you see in-network providers, and you don’t want to be having to sort that out while you or a family member is very unwell.
• Check with your plan to see how telehealth is covered, and be sure you understand how to use the telehealth services.
• If you have an HSA-qualified health plan, try to make contributions to your HSA. Whatever money you contribute to your HSA will be available to withdraw tax-free if you end up needing it to pay out-of-pocket costs for medical care.