As a small business owner, you have a lot to think through as the COVID 19 pandemic continues. We've created resources for you, like our Small Business Owner's Roadmap for Coronavirus and our posts on the CARES Act and Families First Relief Act, to arm you with the information you need to make smart decisions to keep your business and your employees safe.
Is coronavirus covered by health insurance?
If you or your employees get coronavirus, the care will be covered just the same as any other illness, as testing and medically necessary care for you or your employees would fall under what most individual and small business plans call Essential Health Benefits. It also would include doctor visits, hospitalization and support therapy for the symptoms of the infection. There are no limitations and restrictions surrounding the specific condition.
But remember, treatment and diagnosis for the pandemic still brings with it out of pocket costs for the individual and employer, not to mention the system-wide effect coronavirus will have on the health insurance market.
The best course of action is to be educated on your insurance plan and help your employees understand theirs.
How much will coronavirus treatment actually cost my employees?
Testing is now free, thanks to the Families First Relief Act, but estimates for the cost of coronavirus treatment signal high out of pocket costs when the country is reeling from a potential recession—a bad combination for individuals and employers alike.
To understand what potential coronavirus treatment might cost, Peterson-Kaiser Family Foundation Health System Tracker compared it to hospitalizations for pneumonia in 2018.
They found that individuals with health insurance through their employer could pay upwards of $1,300 in out of pocket costs for coronavirus hospitalization.
On top of that, the report estimates that one in five patients hospitalized with a severe case of pneumonia ended up with a surprise medical bill from an out-of-network provider.
Beginning with the total cost of treatment, paid for by a combination of the employer plan and the employee’s out-of-pocket costs, the report found that the average cost of an admission for pneumonia with major complications and comorbidities is $20,292 in 2018.
State-directed health insurance changes
A few states, like New York and Washington, have directed state-regulated health insurer carriers to waive any copayments or deductibles for patients who need tests for the coronavirus. To see what your state is doing specifically, check out this COVID-19 health insurance post from Forbes.
What health insurance carriers are doing to help
Some carriers have agreed to waive member cost-sharing, copays, or other fees. This varies largely by carrier. To see what your specific insurance carrier is doing for its members, check out this helpful link from AHIP.
Understanding health plans and coronavirus
Remember, coverage doesn't mean no out of pocket expenses. The best thing to do is to understand your own insurance plan and help your employees understand theirs, including deductibles and max out of pocket limits. If you are having trouble, call your provider and they will walk you through it. Better to know ahead of time, we always say.
Here are a few important points to keep in mind:
Out of pocket costs: When individuals receive care for coronavirus, they can face out-of-pocket costs that come in the form of a co-pays, deductibles or coinsurance before coverage kicks in.
Lab work & diagnostics: All COVID-19 testing is considered an essential health benefit.
Telehealth: Many health insurance plans partner with Telehealth services (call your provider to check). Teladoc, a teleheatlh provider, lets you call a doctor from your couch at home and never have to leave your couch. That also means that germs are staying at your home too. It's a great complement to social distancing and it means that you'll talk to a doctor and get care quicker than if you had to make a doctor's appointment (it's also cheaper!). We love Teladoc at Take Command Health and include it in our Smart Benefits package that you can buy for your employees so they can call a doctor anytime for free. It can truly be a life saver.
Open enrollment: According to this study, 5 million Americans lost their employer-sponsored health insurance in the recession between 2007 and 2009. We hope your employees aren't in the same boat, but if they do lose their employer sponsored health insurance, eleven states have agreed to let laid off uninsured individuals sign up for Obamacare, instead of having to wait for open enrollment. These states include: California, Colorado, Connecticut, Maryland, Massachusetts, Minnesota, Nevada, New York, Rhode Island, Vermont and Washington.
How will coronavirus affect next year's premiums?
An analysis on the commercial insurance market (not including Medicare and Medicaid) by Covered California concluded that if millions of Americans are hospitalized by coronavirus, insurance premiums could jump as much as 40% next year.
The research also projected that insurers, employers, and individuals are expected to pay between $34 billion and $251 billion in additional costs for the diagnosis and treatment of coronavirus. We hope that's not the case, and we'll be keeping our eyes on these projections as more information comes in.
We're here to help
If you are grappling with your best step forward when it comes to health insurance for your small business during the coronavirus pandemic, chat with our team of experts on our website any time. We would be happy to help.
I wrote this blog because I care about ideas (big and little) that can help fix our healthcare system. I used to work on projects for Kaiser Permanente and the Parkland Health & Hospital System so I've seen the system inside and out. It's so important that consumers keep up with industry shifts and changing health insurance regulations. I'm also Take Command Health's Content Editor and a busy mom. Learn more about me and connect with me on our about us page. Thanks!