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Health Insurance During the Corona Virus

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Coronavirus health insuranceAs we all adjust to lifestyle changes due to the coronavirus, our brokerage is getting questions about what to expect from health insurance policies. We aim to answer those questions below. This information applies to those on individual and group plans as well as Medicare recipients.

We’ll also discuss ancillary policies that are designed to cover unexpected out of pocket expenses. These will apply to those without health coverage and for those who are looking to fill gaps in their existing plans.

Grace Periods for Premium Payments

The government does not want consumers to lose their insurance during this outbreak. This applies to individual and group plans. Grace periods are being put in place for those who may not be able to pay premiums due to job and/or income disruptions.

For individuals on a Marketplace plan, there are some grace periods as to binder payments and regular premium payments. These look to be state specific, but should follow federal guidelines. The grace period can be anywhere from one to three months depending on whether there are ongoing claims. If there are claims, we read this as a one month grace period, but three months for premium payments where there are no claims. It’s best to talk with your insurance company.

For groups, the government wants to avoid layoffs for as long as possible. Even if hours are reduced below full-time (30 hours), members can stay on their group insurance plans. Insurance companies cannot increase premiums and plans cannot be cancelled due to normal participation requirements. There is also a 60 day grace period for premium payments among other measures. Insurance companies should be sending out details of these changes to groups soon.

Individual & Group Health Insurance Plans

The good news is that all major individual and group insurance providers are waiving any copays, coinsurance and/or deductibles that would apply to a coronavirus test. Where available, you should be able to get tested with no out of pocket costs whatsoever.

In fact, Aetna has announced that they will also waive any cost-sharing associated with a hospital admission. This goes well beyond just testing and would be a big relief for those with a high deductible and large out of pocket exposure. Hopefully, other insurance companies will follow suit.

Additionally, short term health insurance plans with most major insurance companies will cover testing costs. Many individuals have enrolled in short term health insurance to reduce monthly premiums. The insurance companies underwriting these types of plans (like United Healthcare, National General, Medical Mutual and others) have all agreed to cover testing with no cost to the insured.

The waiving of out of pocket fees to the insured only covers testing for the coronavirus, however. Should you need more care by a doctor or at a hospital, then your deductibles, copays and coinsurance will come into play. There are ways to account for those costs through ancillary coverage, however. Please read more about that below.

What to Expect if You’re on Medicare

Most Medicare beneficiaries will be in good shape if they’ve purchased supplemental insurance of some kind. There are some exceptions, of course.

Same as the individual and group policies above, all Medicare programs have agreed to waive any out of pocket costs associated with a coronavirus test. Whether you have a Medicare Supplement or Advantage plan, you should not expect to run into any fees with a test.

But should you get sick and need care, then deductibles, coinsurance and copays will apply. If you have a comprehensive Medicare Supplement (like Pan F, G or N), then you have very little out of pocket exposure in case of an illness. Medicare Advantage owners have more out of pocket, however. They could expect to face more bills in the event of an illness.

And most Medicare recipients own a Part D Drug plan – either on a stand-alone basis or as part of a Medicare Advantage Prescription Drug (MAPD) plan. Should you need prescriptions, you can expect your Part D coverage to help offset those costs. And many plans are allowing for early refills. That might be a good idea if movement becomes more limited due to any quarantines.

Medicare has stated that if/when a vaccine becomes available, it will be covered by all Part D Drug plans. This applies to both Stand Alone and MAPD policies.

There is one pitfall with Medicare, however. As of now, it does not cover what are called Under Observation stays. If you were put Under Observation, then Medicare, your Supplement or your Advantage plan may be of little help. There are ancillary policies designed to cover this gap, but they must be purchased separately.

Telehealth Services During Coronavirus

This service applies to all types of insurance policies. The good news is many group plans already offer this service at no additional cost. Unfortunately, most ACA individual plans and short term policies do not at this time, but that’s starting to change.

And the Centers for Medicare and Medicaid services have expanded Telehealth services to all Medicare recipients. This means you can now remotely connect to a doctor if you’re not feeling well. This is helpful for those in rural areas as well as those who would rather avoid a waiting room. This is a very good way to discuss any concerns you might have with a doctor.

What if your insurance plan does not cover telehealth services? You can buy a policy if you wish – either on a group or individual basis. There are a few companies that specialize in offering this benefit. Please contact us if you’d like to learn more.

What if I Don’t Have Any Health Insurance at all?

If you don’t have any health insurance, now is a good time to change that. You can still buy short term health insurance plans (subject to medical underwriting) that can be effective the next day. And these plans can be purchased to last through the end of the year or longer.

And some states are opening up their exchanges allowing consumers who have no health insurance to purchase Affordable Care Act (ACA – Obamacare) plans. Usually these policies can only be purchased during Special Election Periods (SEP) or during the annual Open Enrollment window that runs from November 1 through December 15th.

However, a few states are changing those rules by declaring the coronavirus outbreak a SEP so consumers who have been going without health insurance can buy major medical plans now. Consumers with low income will still be eligible for premium subsidies during this time as well.

If you get laid off, you should ask your HR manager about your COBRA options. If continuing your current insurance through COBRA is not a good fit, then you can shop for an Affordable Care Act – or short term health insurance plan.

Ancillary Coverage to Fill Health Insurance Gaps Now

If you’re worried about gaps in your coverage, high deductibles, being put Under Observations, etc., there are several ancillary policies available. Many companies offer Accident & Sickness policies as well as Hospitalization and Indemnity plans. Like short term coverage, these can be purchased year round subject to medical underwriting approval. Not all who apply will be accepted, unfortunately. You must be in decent health to qualify.

These plans can either pay you or pay the healthcare provider. Some are simply triggered by an accident, sickness or illness and will pay you regardless of your cost. Many of these plans can pay up to $10,000 or more. Policies can also be purchased to cover smaller amounts.

These coverage types offer a great way for those with current insurance to cover their out of pocket exposure. They are also valuable for those who have been going without insurance for any reason. Most policies are very affordable and can be purchased for as long as you wish.

Contact Us For More Information

Hyers and Associates is a full service insurance agency specializing in individual, family, group and Medicare health insurance plans. If you’d like to know more about any of the above strategies and/or policies, call or write us today to learn more.

Category: Health Insurance

Last updated on March 26th, 2020