(Updated March 18, 2020)
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The number of COVID-19 cases in the US is rising, both because the virus is spreading and because testing is starting to become more widely available. Congress has passed a coronavirus relief bill that makes testing free for all patients, insured or not. Does that mean healthcare services related to testing are free too? What should patients who need treatment expect to pay? Well, policies regarding costs for the coronavirus keep changing. Here’s what to know.
Testing is free now?
Yes. Congress passed an emergency coronavirus spending bill that requires both private insurers and government insurance programs like Medicare and Medicaid to cover the cost of testing without cost-sharing. That means both the test itself and any testing appointment are free, whether a patient goes to a doctor’s office, an urgent care facility or an ER to get tested.
Before the bill passed, Medicare and Medicaid were already covering the cost of testing, and most major US health insurance companies were also waiving testing fees. But this legislation reaches patients who either have no insurance or only have skimpy coverage under plans that don’t comply with Affordable Care Act standards.
Are there any potential hidden costs?
Joel Segel, a professor at the Penn State College of Health and Human Development, says that if you go to the doctor for a coronavirus test and your doctor tests you for other things, like the flu, any resulting costs will likely depend on the specifics of your health plan. New Mexico requires insurers to additionally cover flu and pneumonia tests.
Some parts of the country are offering drive-through testing, or planning to start. (Doctors still need to order tests for patients.) Whether or not you need to show insurance information depends on who’s providing the testing. All public health lab testing is free, Segel says. For example, Colorado is offering testing through the state lab, so no proof of insurance is required.
“To be clear, the coronavirus is covered like any other illness, but some plans are moving to remove cost sharing for certain elements,” says Lucas Nesse, president and CEO of the Minnesota Council of Health Plans. “None of these services are free; they are covered by insurance.”
Will insurance pay for my treatment if I have the virus?
Your insurance plan will cover coronavirus-related care the same way they would cover treatment for any other illness, says Rob Fuller, a partner at Nelson Hardiman in Los Angeles and coauthor of From ObamaCare To TrumpCare: Why You Should Care. Ultimately, the amount you’ll pay varies based on your condition and the specifics of your plan’s coverage.
“There’s no special coronavirus coverage. It’s like the flu or anything else,” Fuller says. “You’d pay according to your insurance plan.”
Hospital bills might be higher for patients who are required to stay in isolation rooms rather than shared rooms, says Hyers. To avoid surprise bills, make sure you only visit providers and hospitals that are part of your insurance network, whether you find yourself sick at home or while traveling.
“You want to know ‘here are the places within my network, here are the hospitals or the urgent care I should go to; this is my path, so I don’t find myself out of network and three months later I’m fighting with the insurance company over a much larger bill,’” says Hyers.
The IRS loosened restrictions on high-deductible health plans, advising them to cover coronavirus treatment. That means if a patient with a high-deductible plan needs to be treated for complications from COVID-19, their care should now be covered whether or not they’ve met their deductible. Otherwise, expenses for patients with these high-deductible plans could add up quickly, especially in severe cases that involve an ER visit, blood tests and a CT scan or chest X-ray of the lungs. If a high-deductible plan has an out-of-pocket maximum of $5,000, for example, a patient could reach that maximum “pretty quickly for one ER visit with a workup of pneumonia-like symptoms,” Fuller says.
Will insurance cover my medical expenses if I contract the coronavirus abroad?
Most US health plans won’t cover medical costs incurred outside of the country, Fuller says. In some cases, travel insurance will cover medical emergencies, and some credit cards offer insurance and reimbursement for emergency healthcare.
Depending on your destination, though, you may not need to worry at all about paying for healthcare.
“In some places, health insurance isn’t needed, since healthcare is provided free of charge for everyone,” says Fuller.
But not all countries provide free, universal healthcare, Hyers adds, so travel insurance might be a good way to ensure that you’re covered for a medical emergency overseas.
What will insurance cover if I’m quarantined?
If you’re quarantined at a government-run facility like a military base, the government will pick up the bill, Fuller says. But if you’re ordered into quarantine at a hospital, you should expect to be charged for your stay — which is exactly what happened to some people after a lengthy quarantine hospital stay upon traveling to the United States from China.
What can patients do if they’re quarantined in a hospital and worried about the bill? “Not much,” Fuller says. “The patient could say, ‘I can’t pay for it,’ and they could say, ‘Too bad, you have to go. It’s a crime to violate a quarantine.’”
But there are measures you can take if you believe you’ve been unfairly quarantined, including requesting to bring in your own health expert to evaluate the necessity of the quarantine, or taking legal action through a writ of habeas corpus to request a court-ordered removal from quarantine.
If you’re quarantined, however, Fuller says it’s probably for a good reason. The law also requires an assessment every 72 hours to reevaluate your risk.
“I don’t think anyone administering a quarantine order really wants to hold people in there longer than they need to be,” he says. “It’s for the public good.”
What can I do to limit my medical costs for coronavirus care?
To avoid surprise bills or denied claims, “You really have to trust the system to properly triage you and provide the test and care that a licensed physician determines you need,” Fuller says.
That means if your doctor doesn’t recommend the coronavirus test but you insist on receiving it, your insurer may not consider it medically necessary and could deny the claim, leaving you on the hook for the full bill.
But even medical professionals sometimes order treatments that insurance won’t cover, particularly during a time of heightened panic, Fuller says.
“The problem is that both concerned patients and concerned doctors are going to err on the side of over-testing, so people are going to end up in the hospital, they’re going to get more testing than they would otherwise,” Fuller says. “Insurance at some point will likely push back and not pay for these bills.”
If you’re worried about costs, call your insurance company before you seek care and ask what kind of coverage they offer for testing and treatment. Patients should also avoid the emergency room if they want to keep costs down, Hyers says (unless you’re truly in an emergency).
“The emergency room is the last place you want to go if you can avoid it; that’s where they really sting you,” he says. “Primary care is usually the best; urgent care is a little more favorable, and the emergency room can get really expensive.”
If you’re anxious about the possibility of pricy medical bills, you might want to purchase an ancillary accident and sickness plan to layer on top of your regular health insurance. This optional plan comes at a cost, but it can offer peace of mind.
“These are the types of plans that can reimburse you thousands of dollars if you have some kind of sickness,” Hyers says, adding that an average plan costs around $100 per month. But check first with an insurance broker to learn about the terms and conditions for this type of plan — and to make sure the option is still available.
“As this [virus] spreads, I wouldn’t be surprised to see some insurance companies take some of these plans off the market,” Hyers says. “I’m not going to be surprised if we see the price go up.”