3 FAQs about health care coverage and COVID-19

As the number of COVID-19 cases continues to escalate in the United States, individuals have more questions and concerns about their health benefits and coverage than ever before. Employers have been inundated with requests from employees who need information to stay safe and healthy and to make important health care decisions for themselves and their families. Unfortunately, most HR teams don't have the bandwidth to monitor the ever-changing landscape and to respond to inquiries on a timely basis.

To help, we pulled together the top questions consumers are asking in relation to COVID-19, so employers can proactively engage their employees with the trustworthy information they need.

What is covered by insurance under the new COVID-19 legislative package?

Recent legislation has dictated cost-sharing requirements for virus testing, antibody testing, treatment, vaccine and balance billing—and outlined specific provisions affecting HSA-eligible high deductible health plans (HDHPs).

Testing

Under the CARES Act, coronavirus testing—and any visit to a doctor's office, urgent care clinic or ER that results in an order for the test or the test itself—is free of charge to all U.S. health care consumers. This holds true regardless of whether individuals have insurance or the type of insurance they have.

While, the law states that testing and visits to the doctor's office, urgent care clinic, telehealth or ER must be covered (with no preauthorization requirement) if the services "relate to the furnishing or administration" of a COVID-19 test or to "the evaluation of such individual for purposes of determining the need" of a test, there is still change that the patient will be billed.

People will not get billed if they visit an in-network doctor/facility and the doctor either confirms they need a COVID-19 test or performs the test itself. Individuals may get billed if:

They were tested before March 18, the date the law was signed
Their visit does not result in a COVID-19 test (i.e., the doctor did not deem it necessary)
They get tested by a doctor or facility that is not in-network for their plan
They receive any type of treatment—both related and unrelated to COVID-19

If a patient gets tested at out-of-network, plans will reimburse the facility or provider at the "cash" price the provider has posted on their public website, unless the plan has negotiated an out-of-network rate with that provider.

Antibody testing—once available—must also be covered at no charge.

It's important to note that the cost-sharing waiver for testing is set to expire on June 16th, unless the cutoff date is extended by the administration.

Treatment

Currently, treatment for COVID-19 is not free of charge. If individuals have insurance, they will be subject to the usual deductibles, copays and/or coinsurance. The final cost will depend on what tests they need and the level of care they receive. While some insurance companies are waiving cost-sharing (e.g., copays, coinsurance) for COVID-19 treatment, this is not true of all insurers, so consumers should assume coverage is business as usual.

For those covered by self-insured plans—i.e., their employer pays the bill but an insurance company processes the payment—the employer determines whether to waive the cost-sharing. Even if employers decide to waive costs moving forward, it may not apply to treatment that has already happened or is underway.

While the new regulations permit HSA-eligible HDHPs to cover treatment on a first-dollar basis—and without negating the employee's ability to contribute to the HSA—this is an optional coverage change up to the employer to adopt.

Vaccines

Once a vaccine becomes available, it must be covered as preventive care (i.e., at 100%) within 15 business days after it receives an "A" or "B' rating from the US Preventive Services Task Force (USPSTF) or a recommendation by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention.

High-deductible health plans

The new regulations have loosened several key restrictions on HSA-eligible high deductible plans. In addition to the first-dollar coverage of treatment costs described above, HSA-eligible plans may also cover telehealth services on a pre-deductible basis—even if the visit is not related to COVID-19. This change to cost sharing is permitted from March 27 through December 31, 2021.

Balance billing (aka surprise bills)

The government recently announced that hospitals who accept stimulus funding would be prohibited from balance billing (aka, charging out-of-network patients the difference between the provider's usual charge, and what the employee's insurer will pay). However, it's unclear how the administration would track such billing to hold hospitals and health systems accountable. It's likely we'll see further legislation on this in the weeks and months ahead.

How can people use their health insurance effectively if they do require treatment?

The first step is understanding what's covered, and how. Employees should take some time to do some research on their plan: either calling the member services number on the back of their insurance ID card; finally reading their summary plan description (SPD), which details what their plan covers, how costs are shared and their rights and responsibilities; logging into their insurance carrier's member webpage for more information; or contacting their HR department.

If they are experiencing symptoms, employees should contact their doctor or local health department to determine the best course of treatment. That one phone call can make the difference between treating at home with over-the-counter medications, or a possibly unnecessary (and risky) emergency room visit. Many plans are providing free or reduced-cost telemedicine visits, which can be especially helpful for those who can treat at home.

When employees do require treatment for COVID-19, remember there is no set cost for health care. Expenses may depend on which hospital they go to, whether the facility is in- or out-of-network for their plan, whether the caregivers who treat them are in-network—and of course, the severity of their condition.

If consumers are hospitalized, they should—to the best of their ability—keep track of the following information:

Which doctors they see and when
What treatments and medications they receive
How long they are in each treatment areas (e.g., five hours in the ER, a week in ICU, two weeks in a standard hospital room)

When they are discharged, they should ask for an itemized bill and cross-reference their notes to ensure all information is accurately represented. The last thing individuals should have to worry about during this time is being blind-sided by a surprise medical bill or being overcharged for the treatment they need.

Will health coverage continue if a person loses their job due to COVID-19?

It depends. There are a few possible outcomes for coverage if a person loses their job. Furloughs are essentially unpaid leaves of absence, so it's likely coverage will end on the date of the furlough occurs or at the end of that month. It's possible the employer can negotiate with their carrier or stop-loss insurer to extend coverage for some period of time. If not, individuals should be offered COBRA. Some individuals may also have the option to buy coverage through the ACA Marketplace (or their state's equivalent), Medicaid and/or CHIP.

Employees whose hours are reduced or who are laid off can apply for COBRA, purchase individual coverage (either independently or through the state or federal marketplace), apply for Medicaid and/or CHIP, or, if over age 65, apply for Medicare

If someone loses their job because their employer goes out of business, COBRA will not be an option, but affected individuals can apply for individual, marketplace, Medicaid/CHIP or Medicare coverage, as applicable.

These questions and answers only scratch the surface of COVID-19 quandary. As employees are inundated with more information, they are turning to their trusted source: their employers. HR departments and benefits pros must develop a strategy that communicates updates to their employees frequently and accurately, so individuals can make smart, cost-effective health care decisions during this time.

Kim Buckey is vice president of client service at, DirectPath.

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