Since the COVID-19 pandemic hit the United States in late February, an estimated 6.7 million workers have lost health coverage along with their job. In August, the unemployment rate was 8.4 percent. Even though that number signals a positive trend from the peak of 14.7 percent in April, the stability of many jobs (and their insurance coverage) remains unclear.
While entertaining worst-case scenarios might be stressful, it’s important to have a contingency plan if you or your partner lose your health insurance due to a layoff.
For many people, electing COBRA coverage may be a reliable stopgap measure. But even if you opt for a COBRA plan for 18 months, you should take time to understand the differences in coverage, health care provider network availability, and cost between your COBRA plan and your public and private insurance options. Putting together a cost-benefit analysis can help you realize significant savings during a time when you need your dollars to stretch as far as possible.
With private insurance being as expensive as it is, it’s vital to stay apprised of the latest changes in the government’s social safety net before making a purchase.
But don’t worry—these changes could benefit you. A handful of legislative moves have pushed insurance providers to loosen up some of their usual restrictions surrounding enrollment periods and health care service coverage.
Consider these three developments to better understand how your insurance coverage has changed and ensure that your financial plan reflects the current landscape.
Special Enrollment Period
Health insurance coverage seekers in eleven states now have a broader special enrollment period to sign up for marketplace insurance. Additionally, those who wish to enroll in marketplace insurance do not need to provide a special reason for doing so. At this point, one can presume that the ongoing pandemic is the cause of your change in insurance coverage.
If you live in California, Colorado, Connecticut, Maine, Massachusetts, Minnesota, Nevada, New York, Rhode Island, Vermont, or Washington, the open enrollment offer applies to you. Unfortunately, it’s still unclear whether the federal government will mandate an open enrollment period for the remaining states.
Families First Coronavirus Response Act
The Families First Coronavirus Response Act forces private insurers to cover the cost of COVID-19 testing at no cost to the beneficiary. During this emergency period, coronavirus testing is deemed necessary by the Essential Health Benefits (EHB) guidelines determined by the Affordable Care Act (ACA). Potential treatment, when it’s available, will likely be covered, as well.
The Families First Coronavirus Response Act requires private insurers to:
- Cover coronavirus testing with no cost-sharing (this could change when the United States is no longer under a state of emergency).
- Cover preventative services, including a future vaccine, under ACA-regulated private plans.
Private insurers can (but are not legally required to) cover the costs associated with treating COVID-19 complications. As a result, exactly which items, services, and procedures get covered could vary depending on EHB guidelines.
The Families First Coronavirus Response Act outlines a few exemptions from coverage mandates. Short-term policies, Farm Bureau health plans, and health care sharing ministries are not subject to any minimum coverage standards. Likewise, “mini-med” group policies may not provide coverage for the costs of treating COVID-19.
Medicare and COVID-19
Medicare covers more than 60 million Americans, many of whom are at a greater risk of COVID-19 complications due to an existing medical condition or advanced age. What protections exist for some of the country’s most vulnerable citizens during these times of uncertain health and economic outcomes?
For Americans enrolled in Medicare, the federal government has provided several protections to reduce COVID-19-associated costs. However, there are quite a few caveats.
Your Medicare provider will:
- Allow you to receive telehealth services from any geographic area without having to travel to the “originating site” of the health services in question.
- Cover the cost of the COVID-19 vaccine; all Medicare Part D plans will cover the vaccine if it is a Part D drug.
- Cover the cost of a COVID-19 test as long as a health care provider ordered it after February 4, 2020. Medicare beneficiaries will not need to pay any coinsurance costs or Part B deductibles.
- Cover treatment and hospitalization for COVID-19 if it should occur. However, beneficiaries will still need to pay towards the $1,408 deductible outlined in Medicare Part A.
- Allow you to receive care from out-of-network health organizations at a cost no higher than in-network visits.
Your Medicare provider can (but is not legally required to):
- Relax extended supply and refill-too-soon restrictions for Americans enrolled in Medicare Part D.
- Waive or reduce cost-sharing for COVID-19 related treatments in doctors’ rooms and emergency rooms for Americans enrolled in a Medicare Advantage plan
With millions of Americans unsure of their long-term job security as a result of a pandemic that will likely last well into 2021, understanding your options for health care coverage will help you feel more balanced, better prepared, and less stressed.
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