Even if they shouldn’t, people may think twice about seeking testing or treatment for the coronavirus if they are worried about getting large medical bills, even when they have health insurance.
“The problem is we have reams and reams of evidence that if people know they face hundreds or thousands of dollars in bills, they’ll hesitate, they’ll wait and see,” said Sabrina Corlette, a research professor at Georgetown University.
Policies regarding your out-of-pocket costs for testing and treatment are changing rapidly. State insurance regulators are taking steps to limit how much you might eventually owe, and Congress just passed legislation that would cover the cost of the test. Insurance companies and employers also changed the rules for most plans to eliminate deductibles or copayments for testing.
“Almost every relevant person or entity has said something about holding consumers harmless,” said Katherine Hempstead, a senior policy adviser at the Robert Wood Johnson Foundation.
With the caveat that things are shifting, here’s what you should know:
Is the test for coronavirus free? I have health insurance, but my plan has a high deductible.
Under the legislation just passed by Congress, testing for coronavirus is free, including the cost of a doctor’s visit or trip to the emergency room to get the test.
Worried that residents might hesitate because of the potential bills, many states, including California, New York and Washington, had already required the insurance companies they regulate to cover the cost of a test, according to a recent analysis from Georgetown University.
Private insurance companies had also generally volunteered to waive any costs their members might face for the actual test. Employers who offer plans and are self-insured followed suit.
Government programs like Medicare and Medicaid are also covering the test, which isn’t that expensive — Medicare is paying anywhere from $36 to $51 for the actual test.
People without insurance, or those enrolled in so-called junk plans that don’t meet the standards for insurance under the Affordable Care Act, should also be able to get tested at no cost, said Karen Pollitz, a senior fellow at the Kaiser Family Foundation, which recently released an issue brief on private insurance coverage of the coronavirus.
But could I still end up with bills to pay?
It’s possible, especially if you go somewhere that isn’t in your health plan’s network or undergo an array of unrelated tests. “There are still questions about the battery of testing people may receive and out-of-network testing,” said Cheryl Fish-Parcham, the director of access initiatives at Families USA, a consumer advocacy group.
You could also face sizable out-of-pocket costs if you have something that looks like the coronavirus, like the garden-variety flu, but isn’t. While New Mexico is requiring insurers to cover the testing for flu and pneumonia, so far it’s an exception.
What if I need hospital care?
President Donald Trump told the nation earlier this month that health insurers had “agreed to waive all copayments for coronavirus treatments, extend insurance coverage to these treatments, and to prevent surprise medical billings,” but he misspoke. Your health plan is generally going to view treatment for COVID-19 like the treatment for any other illness, just as if you developed a bad pneumonia or have a chronic condition like diabetes.
“Treatment is still a gigantic problem,” said Fish-Parcham, who said federal lawmakers were talking about another wave of legislation that could potentially address the cost-sharing.
The federal government has made it easier for people in certain high-deductible plans. The Internal Revenue Service recently allowed people in those plans to have coronavirus testing and treatment covered by the plan before they meet their deductibles.
It’s hard to estimate how much you could owe, but the Kaiser Family Foundation provided some ballpark estimates for a pneumonia hospitalization and concluded the total cost could be over $20,000 — with an individual’s out-of-pocket costs running around $1,300. All of those figures depend on what plan you have, where you get care and how serious a case you have.
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No one knows whether employers, insurers or the federal government will move to completely cover these costs, although Joe Biden, the leading Democratic contender for president, has suggested providing emergency funds to cover treatment.
Some plans are taking steps to limit their members’ exposure to high medical bills. The Blue Cross and Blue Shield Federal Employee Program, which covers nearly 6 million federal employees, retirees and their families, said it would waive any copays or deductibles regarding medically necessary treatment.
And some hospital systems are putting a pause on collections. CommonSpirit Health, a Catholic chain of hospitals and clinics, says it is suspending patient billing for coronavirus testing and treatment as it sorts out how the various parties will handle patients’ out-of-pocket costs.
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What about surprise medical bills?
You may be at risk if you get care from someone, like an emergency room doctor or anesthesiologist, who is out of network, even if the hospital is in your plan’s network. When Kaiser did its analysis, it found that nearly 1 in 5 patients admitted to the hospital with a serious case of pneumonia faced out-of-network bills.
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Should I worry about my health insurer being able to pay for the costs?
Probably not. Even if they don’t like them, “insurers are used to surprises,” said Gregory Fann, an actuary in Temecula, California. “That’s what they are there for.”
Most insurers have plenty of capital, and state regulators also keep an eye on them to make sure the companies can pay their medical claims.
And your premiums won’t go up during the current year — insurers set their prices for a whole year so you don’t have to worry about any immediate jumps in costs. It’s impossible to predict what may happen to prices for the following year, although insurers could seek higher rates — and consumers might face higher premiums — depending on the costs of caring for the seriously ill and the length of the epidemic.
Should I worry about my employer coverage?
It’s difficult to predict what will happen to businesses, which are under a lot of strain right now, and their ability to cover your medical claims. Individual companies that experience a surge in health care costs just as sales plummet could face a financial crisis in which they can’t pay medical claims.
What if I don’t have insurance?
You should be able to get covered. If you lose your job, you may qualify for Medicaid or be able to sign up for a health plan under the Affordable Care Act.
A growing number of states are also creating a special enrollment period for residents if they want to sign up, and there is even some talk of the federal government making a similar decision for the marketplaces they operate. There’s also talk of using the Medicaid program much more broadly to cover the uninsured.
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What if I end up with a big bill?
“Don’t whip out your checkbook,” said Fish-Parcham, who also warned that you shouldn’t ignore any medical bills. Contact your insurer as well as the hospital or doctor to find out if you really owe what they say you owe. Be sure to check with your state insurance department as well. You may have been billed in error.
This article originally appeared in The New York Times .