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July 4, 2020


Coronavirus and Health Insurance: What Do I Need to Know?

Novel coronavirus not only requires an expensive test to diagnose but could require extensive treatment – depending on how severe the illness is for you or a loved one. One question that might come up as we all recover from the pandemic is how it will impact insurance.

Are you covered? Will you have to pay a deductible? How much will the test cost you? Will insurance cover an antibody test?

All of these questions are common, especially when discussing insurance coverage amidst the growing concerns over the closed healthcare marketplace.

Coronavirus Testing and Your Health Insurance

Testing is key to reopening the U.S. economy. Not only does a person need a test to see if they have the virus when feeling ill, but they may need a test just to go to work. Some employers are testing on-site or send employees for weekly testing, but who pays for it?

Most insurance companies have announced that the coronavirus test is covered free of charge, and the CARES Act has provisions in place to ensure no one is paying out-of-pocket for a test (even if they are uninsured). The test is considered a diagnostic tool, so your insurance provider should cover it if you have insurance, and in most cases, you will not have a copay.

You may want to check with your insurance carrier as to whether you have a copay or not, or if there is any cost-sharing involved (i.e., deductible). Every carrier is different.

Coronavirus Antibody Testing and Your Health Insurance

Antibody testing is not used to diagnose you with the illness. Instead, it helps determine if you have had and recovered from the illness.

Antibodies, which are also known as an immunoglobulin, are proteins created by your blood’s plasma cells that act as a therapy to neutralize a virus or bacteria. After any infection, your body will automatically respond by creating antibodies. For example, if you catch Influenza-A this year, your body will develop antibodies in response to that very strain, and those antibodies are supposed to protect you from reinfection.

Now, no one knows if coronavirus antibodies make you immune, and even if they did, no one can say for how long. However, antibody testing is another key component of reopening. Some states are considering antibody tests as a determinant for who can return to work, and some individuals want the test for reassurance – making sure that they are not exposing themselves to unnecessary risk if they have not yet contracted COVID-19.

Unlike the diagnostic test, antibody testing may not be covered in full by all insurance companies – not yet, at least. One critical issue is that most of the antibody tests out there are inherently flawed. There are some that give off false positives, while others do not work at all. The FDA did make it easier for manufacturers to create and distribute their own antibody test. Those done by national diagnostic laboratories are more likely to be accurate and possibly covered by insurance, while the at-home or through-the-mail kits are not.

You will need to check with your insurance provider to see if they offer antibody testing and which laboratory they cover through. For example, your insurance provider may cover an antibody test, but only if you receive that test from LabCorp. If you were to receive the test from an outside provider, they may not cover it and you will have to pay out-of-pocket – and it could be an extravagant expense.

Coronavirus Treatment and Insurance

There is no cure for coronavirus, and as of June 2020, there is no vaccine for the virus just yet. However, there are treatments, often which address the symptoms, for COVID-19. If you become severely ill, your physician may prescribe medications to help alleviate some of those symptoms. In more serious cases, you could be hospitalized and require breathing assistance or IV fluids.

If you are insured, your insurance would cover those treatments and hospitalizations just as they would for any other illness. Therefore, you may have copays and deductibles, depending on your plan, along with any applicable cost-sharing. You will want to review your policy to see which out-of-pocket expenses are your responsibility.

What Happens to Those Who Have Lost Their Jobs?

Some Americans started this pandemic with a stable job, income, and insurance, but lost it as the economy shut down. If you lost your insurance through an employer-sponsored program, you may be able to use a Special Enrollment period through Healthcare.gov, but only if you apply within 60 days. Unfortunately, those who did not have insurance before cannot receive coverage through the Healthcare.gov site – only those who lost employer-sponsored programs are eligible.

What If You Cannot Pay Insurance Premiums?

Perhaps you already have insurance coverage, but because you lost your job or your hours were cut, you no longer can afford your health insurance premiums. Check with your insurer, because many have offered grace periods during the pandemic to accommodate these very situations. In most states, this grace period is 30 days, but some have extended it due to longer shutdowns.

You should update your information in the Healthcare.gov system, because, with your new income situation, you may qualify for a lower monthly premium as well – making it more affordable to keep your insurance coverage.

Worried about Long-Term Coverage or Medicare? Meet with a Local Attorney

Now is the best time to start planning for the future. Even if you are in between jobs or you are in quarantine, you should start planning for long-term care and possibly applying for Medicare. You can also work on updating your estate plan and planning ahead for global health crisis situations just like this that can occur again in the future.

To explore your options for long-term care, discuss what you need to do so that you qualify for Medicare, or just to explore your estate planning options, meet with a trusted local attorney at the Law Office of Andrew M. Lamkin, P.C. We can do a no-obligation, over-the-phone or video consultation to accommodate your needs.

Schedule by calling our office or contact us online with your questions.