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Does your health insurance cover costs related to coronavirus? Here's what you need to know

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The economy is opening up and many Americans are beginning to return to a more normal version of everyday life. But that doesn't mean that the coronavirus is going away: New cases are still increasing in more than a dozen states, and experts say another spike in cases could occur later this year.

With that in mind, it's important to understand whether or not you're covered for Covid-19 related health-care costs, including testing, treatment, and hospital stays. A hospital stay for the virus could cost up to $30,000, according to a study from trade group America's Health Insurance Plans — and if you're uninsured, you could be looking at bills adding up to almost $75,000, per an analysis by independent nonprofit FAIR Health. 

Experts say you should think of potential medical expenses in two separate buckets. Those are "testing and treatment," says Sunit Patel, chief actuary at Mercer, a global consulting firm. 

Whether you're covered for testing or treatment can depend on your individual situation and even on your specific health insurance plan. "It's like comparing snowflakes," says Karen Pollitz, a senior fellow at the Henry J. Kaiser Family Foundation, about the different types of insurance plans in the U.S., all of which will likely handle treatment costs differently.

Here's what you need to know.

VIDEO4:1504:15
Does your health insurance cover coronavirus

Video by David Fang

Coronavirus testing: Covered if you're insured

First, the good news: Testing to see if you have Covid-19 is covered and you shouldn't incur any out-of-pocket expenses for a diagnostic test if you have health insurance.

Two pieces of legislation passed in March made diagnostic testing available at no cost. The Families First Coronavirus Response Act (FFCRA), signed into law on March 18, and the CARES Act, which became law on March 27, stipulate that testing at doctor's offices, urgent care clinics, and hospitals is available at no out-of-pocket cost to people who need it.

"Private insurance, Medicaid, and Medicare are now required to cover testing for the coronavirus 100%, with no deductibles or copays," says Pollitz.

If you're uninsured, though, you may have to pay to get a test. There should free options, too: Many local public health departments, community health centers, and other organizations may offer free tests, Pollitz says, but you'll need to contact them directly to see what your options are.

The CARES Act did set aside some funding for hospitals to help pay for the uninsured get tested, Pollitz says. But the law doesn't say how much funding there would be, and it's up to each hospital's discretion as to whether they'll test the uninsured free of charge. 

Coronavirus treatment: Might be covered

If you require treatment for Covid-19, whether or not your costs are covered in full or in part will depend on your insurer, and possibly on your employer. 

Although many large insurers voluntarily waived copays, deductibles, and cost-sharing requirements for a couple of months, those provisions are due to sunset at the beginning of June. That means that out-of-pocket costs for patients could go up as those charges kick back in.

And while those on Medicaid or Medicare are likely to have most, if not all, of their costs covered, experts say, people with private insurance plans will find that a lot has been left up to insurers' discretion. So what you could end up paying out-of-pocket for treatment can depend on the specifics of your insurance plan. 

Laws like the CARES Act did not stipulate that insurers are compelled to cover the full cost of hospital stays or other treatments related to coronavirus. "When you look at treatment, that's where [insurers have] latitude," says Patel. "Whether the plans cover treatment costs … is anyone's guess."

Whether the plans cover treatment costs … is anyone's guess.
Sunit Patel
Chief actuary, Mercer

Will insurers choose to continue to waive copays and deductibles on procedures and treatments related to the virus? Patel says that the decision will likely come down to the "financials." Same with whether or not insurers will opt to fully cover antibody tests.

To find out how much you'd end up paying out-of-pocket for a hospital stay or other treatments for Covid-19, you'll need to reach out to either your employer's HR department or your insurer. "There are literally millions of employer plans out there," says Pollitz, and "there are no rules" as to what insurers do and do not need to cover, or must offer their customers.

So, because there are so many plans out there and each is different, it's up to you to proactively reach out to get answers, she says. "To make sure you're covered, you'll need to call your insurer."

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