For the last few years’ healthcare reforms have been in the news for various reasons. And if you are wondering what’s happened and what’s going to happen in 2020, you’re certainly not alone. Let’s discuss here what’s staying the same, what’s changing, and what you can expect in terms of your medical insurance in 2020.
As per the nonpartisan Kaiser Family Foundation reports, nearly 27 million Americans have lost their insurance coverage amid the COVID-19 pandemic. Another analysis, by the Urban Institute and the Robert Wood Johnson Foundation, has estimated that by the end of 2020; nearly 10.1 million people will no longer be covered under their employer’s health insurance coverage due to loss of job because of the pandemic. And those losing their medical coverage could face exorbitant costs if they get diagnosed with Covid-19, which has sent the seriously ill to ICU’s for weeks, and sometimes months.
A recent survey also indicated that more and more consumers are now keen to avail health cover. The unabated spurt in novel coronavirus cases is leading to an increase in demand for online medical insurance plans. Coronavirus pandemic has been an eye-opener for almost everyone, reinstating why an insurance cover is indispensable. While a lot of people are already covered under some form of health insurance or another, it is vital to check what the policy is offering to understand how beneficial it will be in case of hospitalization due to coronavirus. Health insurance plans help secure your finances by covering the cost of medical treatment. At the same time, it is imperative to verify if the plan also covers the cost of testing, quarantine, and consumable items like PPE kits, ventilators, masks, oximeters, etc.
People who have employer health insurance policies will be informed if any changes are lined up this year. And those who have government-run Medicare or Medicaid insurance – Medicare Advantage, Medigap, Medicare Part D, or a private Medicaid managed health care plan, they will also receive communications from the insurance provider or federal or state government
Although most of the people diagnosed with this new coronavirus are able to recover at home, 15% of the patients who get hospitalized need to pay staggering costs. While there is news regarding clinical trials of the COVID-19 vaccine, some experts believe that there may not be a coronavirus vaccine at all. During such unprecedented times, health insurance cover becomes inevitable. And while most of the health plans cover COVID-19 treatment costs, figuring out what is paid for – and what isn’t – can sometimes be confusing.
Here is a quick rundown of what you can expect from your health insurance provider if you need treatment for COVID-19.
100% cost of SARS-CoV-2 testing shall be covered in all the comprehensive health insurance plans ( as per the Affordable Care Act, ACA), along with the visits to the doctor’s office, emergency room, or care center followed by the diagnostic procedures, including all the Coronavirus tests as reckoned appropriate by the U.S. Department of Health and Human Services.
If you’re covered under a short-term medical policy or another policy that isn’t ACA-compliant, your insurance company may not cover the cost of testing. However, Medicaid will pay for the complete cost of testing for the uninsured, as per the CARES Act.
Medicare Part A and Part B would continue to charge deductibles and co-pays for hospitalization and doctor visits. Most of the Medigap policies would also cover the deductibles and co-pays, and other costs stemming from coronavirus treatment.
Anyone with a Medicare Advantage plan, their coronavirus treatment cost-sharing will depend on the type of plan that they have. Medicare Part A and Part B cover only prescription drug drugs.
Medicare Advantage plans only cover network providers, and during this time the government requires to revamp these plans to include out-of-network providers as well.
In view of the COVID-19 pandemic several insurance providers, including Aetna and Cigna have waived off deductibles, co-insurance, and co-payments, deductibles in the case of coronavirus related hospital treatments. Other insurers are also taking initiatives to minimize out-of-pocket expenses related to COVID-19 testing and treatment.
Most of the waivers are applicable to only in-network care. There are some companies like AllWays Health Partners that will cover out of network patient cost-sharing in case of unavailability of in-network providers. Some of the worst hit parts of the United States where COVID positive patients are directed to certain hospitals that are not a part of your insurer’s network, leading to financial turmoil.
Some insurers also offer waivers for a specific time period or month, while some waive it off indefinitely. Not every insurer will cover the cost in full. To clear off the confusion regarding cost-sharing it makes sense to check with your insurance provider to find out the scope of coverage in case you require treatment for the virus.
And if someone needs to undergo coronavirus treatment, there’re a lot of things involved including medications, tests, and the course of treatment. Clearly, that’s not easy for someone who is critically ill and is kept in isolation. During isolation, they can sign an authorization form that will allow a family member of yours to coordinate with the hospital and doctors on your behalf. This will ensure that you do not get any shockers when the bill arrives at the end of the treatment.
If you are taking treatment of coronavirus in the USA and are uninsured then you can expect the medical bill to range anywhere between USD 14 billion to USD 42 billion, as per the Kaiser Family Foundation estimation. And it doesn’t include out-of-the hospital treatment expenses.
To cover the costs of COVID-19 treatments, the Government has announced allocating USD 100 billion towards the funding of these hospitals and other health care providers. It not clear how the funding will be distributed, but the federal funds are likely to cover the uninsured.
COVID-19 positive patients who have recently lost their employer medical insurance cover may also qualify for Medicaid coverage, and they can check for the same in their state.
It might not be possible for everyone to afford the same kind of medical insurance provided by their employers, any amount of coverage is beneficial than not having insurance at all. In case of any unprecedented onset, and any other serious illness including SARS-CoV-2, you will be better prepared.