Insurance and COVID-19: What to Know.

Posted by Reeve Staff in Daily Dose on March 26, 2020 # COVID-19, Insurance

Insurance providers are adapting coverage and services in response to the public health crisis created by the spread of COVID-19. The changes, which vary depending on individual policies, range from increasing telemedicine coverage to waiving all fees and co-pays for COVID-19 testing. The information below highlights some of the changes, but in addition, you should take some time to research and understand your specific coverage plan in order to be prepared ahead of any emergency.

TestingMedicare

  • The Families First Coronavirus Response Act, passed by Congress on March 18, 2020, requires Medicaid, Medicare and most private insurance companies to provide free coronavirus testing and waive any co-pay fees or deductibles. The law mandates coverage of services, including doctor’s office, urgent care, telehealth or emergency room visits, related to administering or determining the need for a test. Not everyone will need to be tested, but take time to prepare, just in case: Research your individual insurance plan to understand if there is a specific in-network provider or testing site you would need to use to avoid surprise charges.
  • If you don’t have insurance, you are still eligible for free testing. The law includes emergency funding to directly reimburse doctors and medical facilities for tests and test-related services performed on anyone who is uninsured. An increase to Medicaid funding also gives states the option to cover uninsured residents and temporarily enroll them in the program in order to be tested.

The law mandates free testing –not free treatment– for COVID-19. Treatment costs will vary depending on individual coverage plans.

Insurance Expansion and Changes

  • As of March 24, the outbreak had prompted Washington, Colorado, California, Connecticut, Maryland, Massachusetts, Nevada, Rhode Island, Vermont, New York and Washington, D.C to open special enrollment periods under the Affordable Care Act for people who are currently without insurance.

These states run their own exchanges. As of March 24, the federal government, had not announced any new enrollment expansion periods for the markets it manages in 32 states.

  • Both Medicaid and Medicare are making changes in response to COVID-19, including:

In order to continue provide Medicaid services and supports for people who are quarantined and already meeting an institutional level of care, states (using the authority outlined under Section 1915 (c)Appendix K regarding action in emergencies,) can authorize healthy family members living in the home to serve as a provider and receive funding as a “live in caregiver.” Home-delivered meals, such as Meals on Wheels, could also be added to provide one meal per day to the individual. In addition, other services could be added, including private duty nursing, and payment rates could be increased to offset the increased health risk to providers and appeal to a larger provider pool.

Medicare has temporarily expanded its coverage of telehealth services to help people access doctors and other health providers (including nurse practitioners, clinical psychologists and licensed clinical social workers) without having to go to a doctor’s office or hospital and risk exposure to COVID-19. Specific services available remotely include evaluation and management visits, mental health counseling and preventive health screenings.

For more comprehensive information and updates about changes to these programs during the outbreak, please visit Medicaid’s COVID-19 Frequently Asked Questions and the Medicare and Coronavirus webpage.