Rules to Pay for Corona Care Expenses

A KAISER Family Foundation’s study discovered that Inpatient hospital admissions cost for COVID-19 is around $20,000, and it is much more if ventilator support is required. Based on the pneumonia experience, it was found through analysis that employer-sponsored policyholders admitted to the hospital for COVID-19 treatment may face average out-of-pocket costs of more than $1,300. People having a high-deductible health plan may have to pay $2,000 or more for COVID-19 treatment.

Some health insurers in the U.S. are expanding coverage for COVID-19 tests, and are voluntarily waiving cost-sharing for some of the COVID-19 treatment expenses. People need to know the rules, as there are ways to reduce care and testing expenses. People should know the coverage rules for testing, should check whether their insurer is waiving some out-of-pocket costs, should take advantage of telehealth, and should raise voice against surprise medical bills. Upon losing jobs, people should avoid coverage gaps, should sign up for Medicare on turning 65 and upon losing their job, and should make use of tax-free money for out-of-pocket expenses.

Be Aware of the Testing Coverage Rules

Health insurance carriers, as per the federal law, are required to cover the full cost of coronavirus tests, and the cost of the healthcare provider visit to administer the test. They are required to cover the full cost irrespective of the fact that whether it is an urgent care center, emergency room or office visit. People don’t have to pay any co-payments or deductibles if they visit a doctor for the result screening of the coronavirus test. However, it doesn’t mean that people will not get a bill, as some people reported that they were charged for the test despite having insurance. There is no such requirement that healthcare providers cannot bill, but insurance carriers are required to cover. If healthcare providers are billing people, then they can take the receipt and submit to their insurance companies, and they have to reimburse the amount.

Check whether Insurer Is Waiving Other Out-of-Pocket Costs

Health insurance carriers, as per federal rules, are not required to cover out-of-pocket costs that are not related to coronavirus testing, though some of the carriers are voluntarily waiving certain other charges. There is some bit of confusion around, as per the federal requirement, the only clear thing is that there is no cost-sharing for testing, but there is no clarity on the treatment cost. Some of the health insurers are covering COVID-19 treatment without cost-sharing, therefore people are confused, whether their carrier is covering the treatment cost or they would be responsible for cost-sharing.

The treatment costs vary by the insurer, for instance, Cigna is waiving co-payments and cost-sharing for COVID-19 treatment through May 31, 2020, whereas some Blue Cross Blue Shield plans are waiving deductibles, co-pays, and coinsurance for medical treatment through June 30, 2020. Therefore, to have clarity, people should check rules with their insurance carriers and should keep up with the changes.

Avail Telehealth Advantage

Health insurance carriers, as well as Medicare, are expanding coverage for telehealth services. The coverage has been expanded to prescreen people for coronavirus tests and to meet with doctors for other health issues without stepping out of their homes. Telehealth services need to be covered with no cost-sharing if a coronavirus test has been ordered. In addition to this, some insurers are temporarily waiving cost-sharing for some other telehealth visits too.

The cost of telehealth services is much less compared to in-person visits for minor health issues. The national average cost for a video-based virtual visit is $50, compared to $85 for treatment of minor issues at a doctor’s office, $130 for an urgent care facility visit and $740 for an emergency room visit, as per UnitedHealthCare.

People should appeal against Surprise Medical Bills

It has been revealed through studies that some patients face at least one surprise medical bill. As insurance carriers pay only a limited amount for the out-of-network care, then the healthcare provider bills patient for the extra charges, which is called balance billing. Though, several states have passed laws to protect patients from surprise medical bills, and have prohibited healthcare providers from sending these additional bills or providing an arbitration process. However, sometimes healthcare providers send a balance bill to patients even if they are not supposed to pay it. Therefore, if patients get such a bill, which they think their insurance carriers should have paid, then they should call their insurance company, as they have the right to appeal. They can find about their state’s protections and can find links to their state insurance department through the map of the National Association of Insurance Commissioners.

Avoid Coverage Gaps in case of Loss of Jobs

In case of loss of job and employer-sponsored coverage, people should find ways to remain covered. People whose employers have 20 or more employees can continue their employer’s coverage for up to 18 months after the loss of their jobs under a federal law called COBRA. In this way, people can keep the same provider network and coverage but their premium cost will increase, as they will have to bear the premium cost of their employer as well along with their own premium cost.

People can also avoid coverage gaps by getting individual coverage through Healthcare.gov or their state’s insurance marketplace. They just have a 60-day special enrollment period to sign up for an individual plan after losing their employer-sponsored coverage. Some states have also come up with a temporary open enrollment period for people who didn’t have coverage. Depending upon their 2020 income and the number of members in their family, individuals may qualify for a subsidy that will help to pay the premiums.

Individuals whose spouse has employer-sponsored coverage may be able to include in their spouse coverage, provided their employer allows them to be included. People may also qualify for Medicaid plans depending upon their income and the state in which they are residing. People can check their eligibility and other related information at their state marketplace or state Medicaid office, Medicaid.gov. People can also consult with their local health care navigators, who can effectively assess their coverage options.

People of age 65 or older who have lost Jobs Can Sign Up for Medicare

People are allowed to enroll in Medicare plans, starting three months before to three months after the month they turn 65 years of age. Despite the closure of the Social Security field offices due to coronavirus, people can enroll in Medicare online at the Social Security website, even if they do not wish to sign up for Social Security yet. People who have signed up Medicare Part A but not for Part B because of their job have eight months after leaving their job as well as coverage to add Medicare Part B without a late enrollment penalty.

Use Tax-Free Money for Out-of-Pocket Expenses

People can make use of tax-free money from a flexible spending account or health savings account to pay for their out-of-pocket costs for coronavirus expenses or other eligible medical expenses. With HAS account people can use the money tax-free for out-of-pocket costs and other eligible medical expenses anytime, and money can be used for even years in the future.

People who had a HAS-eligible health insurance plan in 2019 with a deductible of at least $1,350 for single coverage or $2,700 for family coverage can make tax-deductible contributions to their account until July 15, 2020. People can contribute up to $3,500 to their HAS if they have single coverage or up to $7,000 for family coverage, along with $1,000 if they were 55 or older in 2019. People can use this tax-free money for their medical expenses anytime.

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