Even though it is good news that a lot of people have gotten vaccinated and are still practicing social distancing, the coronavirus is still something to be cautious of. If you contract this virus, it’s possible to incur a lot of medical expenses even if you have health insurance.

You might be wondering, “does health insurance cover COVID-19 treatment?” and “does health insurance cover COVID-19 testing?”.  Coronavirus coverage can be a bit complicated, so you’ll need to do some research. Keep reading to learn more about health insurance and COVID coverage and how to get it when you need it.

Is coronavirus covered by insurance?

If you have health insurance, either through an employer-sponsored plan or a Marketplace plan, you are covered for medical services and treatment as outlined in your plan’s coverage policy. In other words, there isn’t specific “coronavirus health insurance coverage,” per se. Instead, your health benefits for coronavirus medical care, like any other illness, will depend on your specific plan benefits.

Health insurance coverage for coronavirus may include services like:

• Diagnostic testing for COVID-19 when ordered by a doctor. COVID-19 tests are available at no cost nationwide at health centers and select pharmacies.
• Urgent or emergency room care
• Inpatient hospitalization, including any medically necessary medications, supplies, or equipment
• Outpatient services, including doctor visits, labs, and X-ray services

In addition, many insurance carriers are expanding certain services or benefits in response to the COVID-19 pandemic. New telemedicine services may be available for doctor consultations, mental health counseling, and more to minimize the potential risk of exposure to the virus. Check if your provider covers telehealth care.

In addition, many insurance carriers (as well as Medicare) expanded certain services or benefits in response to the COVID-19 pandemic. New telemedicine services may be available for doctor consultations and mental health counseling to minimize the potential health risks of exposure to the virus.

While insurance companies are waiving out-of-pocket expenses for diagnostic testing during this public health emergency, you may still owe other applicable copayments, coinsurance, or deductible costs for the treatment of coronavirus. For the most accurate and up-to-date information, check with your own insurance company to find out what’s covered by your specific health plan and what your costs may be.

Will health insurance cover the COVID-19 vaccine?

Soon after the COVID-19 pandemic reached the United States, laws were passed to ensure most Americans would be able to receive the vaccine at no cost regardless of whether they had private health insurance, Medicare, Medicaid, or were uninsured. In most cases, insured and uninsured Americans will pay nothing for COVID-19 vaccines for the duration of the public health emergency. As of July 15,2022, the U.S. Department of Health & Human Services (HHS) extended the public health emergency through September 15, 2022, and the HHS may extend it further, as necessary, in 90-day increments.

After the public health emergency ends, you may experience a change in COVID-19 coverage and find that you are responsible for a portion of the vaccine administration cost. Therefore, it is important to learn specifics about your plan. 

While health insurance plans vary, listed below are some general guidelines.

• Private health insurance companies will likely cover COVID-19 vaccines the same as other preventive services.  If you are insured by an ACA marketplace plan or, in many cases, an employer’s group health plan, your insurer will probably pay 100% of the cost of the COVID-19 vaccine under the essential health benefits rules. In this case, it is likely that you would pay a copayment, coinsurance, or deductible for the administration of the COVID -19 vaccine only if your doctor’s visit also involved diagnosis or treatment of a health condition unrelated to the COVID-19 vaccination. Your plan’s coverage may also depend on your use of providers in your plan’s provider network.

• Medicare and Medicare Advantage plans will cover COVID-19 vaccines the same as other preventive services covered at 100%.  Your plan’s coverage may require you use providers in your Medicare Advantage plan’s network.

• Medicaid coverage of the COVID-19 vaccine could vary depending on the person’s eligibility category, but the majority of enrollees will likely continue to have access to zero-cost COVID-19 vaccines. This includes children as well as adults who are eligible under the ACA’s expansion of Medicaid.

The government’s requirement to cover the cost of COVID-19 vaccine does not apply to some types of health insurance. However, the insurer may decide to voluntarily cover the cost of COVID-19 vaccines during the public health emergency and, perhaps, afterwards.  Plans that are exempt from the requirement include:

• Short-term medical plans
• Fixed, limited coverage indemnity plans
• Farm Bureau plans
• Health care sharing ministry plans

If you are enrolled in one of these types of plans, be sure to contact your plan administrator to find out what type of coverage restrictions or limitations may apply.

Can I get the COVID-19 vaccine if I don’t have health insurance?

While there is no federal requirement to provide COVID-19 vaccine coverage to uninsured adults, the government has provided funding to reimburse medical providers who administer COVID-19 vaccines to Medicare, Medicaid and uninsured adults. If you are uninsured, the vaccinator can submit a bill to the federal Provider Relief Fund.

The Vaccine for Children (VFC) Program provides uninsured children access to vaccines from participating pediatricians. Doctors may bill the parent a modest administration fee for the service.

Does health insurance cover COVID booster shots?

As of now, most health insurance plans cover COVID-19 booster shots, often at no cost to the insured, following guidelines set by public health authorities. This coverage is part of an effort to ensure widespread immunity and manage the ongoing impacts of the pandemic. The availability of free booster shots is typically extended to those covered under private health plans, Medicare, and Medicaid, as insurers continue to support preventive measures against COVID-19. However, it’s essential to verify the specifics with your insurance provider, as policies may vary based on the plan and any updates to national health guidelines or legislation. Always check for the latest information to ensure you have the most accurate understanding of your coverage for COVID-19 booster shots.

Will health insurance cover COVID-19 over-the-counter tests?

Does health insurance cover COVID testing? In general, health insurers will cover the cost of a coronavirus test if it is medically necessary. If you are simply purchasing a test over the counter, you need to take a look at the details of your health insurance plan to see if this type of expense will be covered.

The good news is that even if your health insurance company will not cover the full cost of a coronavirus test, there is a chance that you could be reimbursed by another source. For example, you may want to take a look at the information provided by the CDC or FDA to see if you can get reimbursed for your coronavirus test. 

Remember that there might be resources where you can get an over-the-counter test for free.

Does health insurance cover out-of-network testing?

In many cases, yes. When it comes to health insurance for COVID, the good news is that even if you are out-of-network, most health insurance providers are generally required to cover the cost of testing at no expense to the policyholder. That means that if you have been exposed to COVID, regardless of where you are located, your insurance company has to cover the cost of your test, even if you are out of network. 

Check the specifics of your coverage to confirm whether testing costs are paid for by your insurance.

Can I still get health insurance if I have coronavirus?

If you’re uninsured, costs related to coronavirus testing and treatment can be prohibitive. Diagnostic testing may range from $500 to $1,000, and for those who need inpatient hospitalization, costs can run between $75,000 to $100,000 for a 10-day period, according to a CNBC report.

If you do not currently have coverage, you may still be able to buy health insurance even if you have coronavirus.

Marketplace health insurance

While the Open Enrollment Period for a Marketplace plan is over, you may be able to enroll in coverage through a Special Enrollment Period if you have a qualifying life event, such as job loss, relocation, or household changes. So, for example, if you had employer-based coverage and lost your job, you may qualify for a Special Enrollment Period. A Marketplace plan cannot exclude you from coverage based on a pre-existing condition, including a COVID-19 diagnosis.

Short-term health insurance

The general waiver of copayments and deductibles for COVID-19 testing also applies to almost all short-term insurance plans. However, short-term insurance plans are meant to provide temporary, limited coverage and do not cover pre-existing conditions. So, if you have a diagnosis of coronavirus prior to the start of your short-term plan, you probably will not be covered for treatment costs for that condition. Additionally, this policy might not cover things like prescription drugs, preventive screenings, maternity care, emergency services, hospitalization, pediatric care, physical therapy & more. This type of plan might have no cap on out-of-pocket expenses for care, does not qualify for federal financial assistance to help with premiums and out-of-pocket costs, and is not required to meet federal standards for comprehensive health coverage. Because coverage details may vary by insurance company, check with your insurance company to see exactly what your plan covers.

COBRA

As another option, if you were recently laid off and had health coverage through your job, find out if your employer offers COBRA coverage, which temporarily continues your employer-based health coverage. Be aware, however, that COBRA premiums are paid entirely by the individual, without employer contributions, and tend to be very expensive. This type of coverage is meant to be a temporary bridge until you’re able to find other coverage.

We recognize that you may have additional questions about health insurance, particularly during this COVID-19 pandemic. We are here to help answer your insurance coverage questions. Our licensed agents can also assist you in finding the right health coverage to meet your personal needs. Feel free to contact us at the toll-free number on this page or chat online with us.

Can an insurance provider cancel my healthcare policy if I am diagnosed with COVID-19?

Since the Affordable Care Act went into effect, every plan purchased on the marketplace has to provide coverage for pre-existing medical conditions. They also cannot terminate your health insurance plan if there is a change in your health status. That means even if you are diagnosed with coronavirus, and even if you require a tremendous amount of treatment, they are required to honor the agreement, terms, and conditions of the plan, and they are not allowed to cancel your plan purely because you got the coronavirus.

Can my insurance provider refuse to renew my policy if I am diagnosed with COVID-19?

Does health insurance cover COVID treatment? Many people are concerned that their health insurance provider may refuse to renew their plan just because they have been diagnosed with COVID-19. Federal law prohibits health insurance companies from refusing to renew someone’s plan just because they have been diagnosed with a chronic medical condition. This includes COVID. 

Even if you have been diagnosed with the Omicron variant, your health insurance company is still required to renew your policy. Therefore, you should not have to worry about your health insurance company canceling your health insurance plan, or refusing to renew your health insurance plan, purely because you have been diagnosed with COVID.

Find and compare your health insurance options

If you are looking for health insurance options, it would be our pleasure to help you. We understand how difficult it can be to sort through the different health insurance plans available. For example, you might be curious about COVID-19 health insurance for travel and want to focus on safe travel when you go overseas. Or, you might be concerned about your kids getting exposed at school.

Everyone is in a slightly different position. The right plan for one person is not necessarily going to be the right plan for you. You can use our comparison tool to learn about the details of each health insurance plan and find the right coverage for your family at a price you can afford.

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Our mission at eHealth is to support the health and well-being of individuals and small-business. For additional coronavirus advice, health tips, and information on coverage, please visit eHealth.com

For information and guidelines specific to the coronavirus outbreak, visit cdc.gov

This article is for general information and should not be relied on as medical advice. Check with a medical professional for medical advice.  Check with your particular insurance company to see what is covered by your particular insurance plan.

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