As Unemployment and COVID-19 Cases Rise, Who Will Pay for Care?
The coronavirus pandemic is spreading across the United States at the same time that millions have been laid off from their jobs.
That raises the obvious question -- how will those newly unemployed folks pay for medical care if they become infected with the coronavirus?
Recent bills passed by Congress ensure that people won't have to pay out of pocket for any COVID-19 testing, even if they're uninsured, but there's nothing that would cover treatment costs for people without insurance.
However, provisions in the Affordable Care Act -- including the Medicaid expansion and the insurance marketplaces -- have created a safety net that should help many of the unemployed get the medical coverage they need, experts say.
Horror stories are already surfacing of people being hit with surprise medical bills in the wake of COVID-19 testing and treatment.
A computer science professor at Bennington College in Vermont tested negative for COVID-19, but he's already been charged nearly $2,000 in medical bills and fears there's more to come, the New York Times reported.
"I was under the assumption that all that would be covered," Andrew Cencini, who makes $54,000 a year, said in the Times. "I could have chosen not to do all this, and put countless others at risk. But I was trying to do the right thing."
If you're newly unemployed, the first thing you should do is check to see what your state or your insurer has done to protect health coverage during COVID-related lockdowns, said Cheryl Fish-Parcham, director of access initiatives at Families USA, a consumer health care advocacy group.
"Health insurance has extended some grace periods to make sure that both employers and employees can pay their share of premiums during this crisis and they don't just get cut off arbitrarily because no one was in the office," Fish-Parcham said. "Some states have issued an order that there be no cancellations during this period."
Folks who are laid off and have lost their coverage should look hard at enrolling in Medicaid, said Karen Pollitz, a senior fellow studying health reform and private insurance for the Kaiser Family Foundation.
"If you lost your job and you don't have any income currently, even if you were earning a lot, you currently can be eligible for the Medicaid program if you're in a state that expanded Medicaid eligibility for low-income adults," Pollitz said.
Medicaid is based on your current income, and unemployment checks aren't counted -- even the $600 bump in unemployment that was part of Congress' recent stimulus bill, said Dr. Peter Ubel, a professor of business, public policy and medicine at Duke University in Durham, N.C.
Most states don't charge a premium for Medicaid, and benefits are comprehensive with no deductibles, Pollitz said.
"Medicaid is the most affordable option. Start there," Pollitz said. "It's not a welfare-based benefit anymore. It's really a safety net for people when their income is low. When you get your job and your income back, you can let the Medicaid go."
There are 14 states that haven't expanded Medicaid to cover more low income people -- Wyoming, South Dakota, Wisconsin, Kansas, Missouri, Oklahoma, Texas, Tennessee, North Carolina, South Carolina, Mississippi, Georgia, Alabama and Florida.
In those states, people's next best option will be getting on the health plan of a spouse or parent, Pollitz said. The ACA allows people who've lost coverage to enroll in their spouse's plan or, if they're younger than 26, their parents' plan.
"You only have 30 days and you won't get a notice," Pollitz said. You'll need to proactively reach out to the human resources department at your family member's work and let them know you want to enroll.
If those options aren't available, your next most affordable move is to go to a marketplace and purchase health insurance coverage, Pollitz said.
Most states run their marketplaces through the federal HealthCare.gov, which allows a special personal enrollment period for people who've lost their coverage, Pollitz said.
"You have 60 days from the day you lost coverage to go to the marketplace," Pollitz said. "You have to let them know you lost your coverage. You have to jump on this."
Marketplace plans are subsidized for people who earn less than four times the poverty level, which is around $50,000 a year for a single person and around $105,000 for a family of four, Pollitz said.
It's even easier if you live in one of 12 states that run their own marketplaces, because those states have simply opened up a special enrollment period during this crisis, Pollitz added. You have until mid- to late April to enroll.
The last option and least affordable is COBRA, the 1980s-era law that allows people to keep their job-based coverage if they are laid off.
"The trick is you have to pay the whole premium yourself," Pollitz said. "On average, employers pay about 80% of the premium for workers. The average group health plan now for self-only coverage is over $7,000 a year, so we're talking a lot of money. If you've just lost your job, most people aren't going to be able to afford COBRA."
Even though it is pricey, this could be a good option for people who are receiving treatment for cancer or some other life-threatening illness, or are pregnant, Pollitz said.
"You literally keep the coverage you have," Pollitz said. "If you've already satisfied your deductible, you don't have to start a new one. If your doctors were already in network, they're still in network. It's all still the same."
The House of Representatives had considered a proposal to subsidize COBRA 100% during the crisis, "which would have been life-changing for a lot of people," Pollitz said. Sadly, that provision was not passed into law.
All this can be head-spinning and anxiety-inducing, and Ubel is concerned that many people won't seek the care they need because they're worried about expenses.
"The bottom line for people is, don't let money get in the way of getting the care you need. We'll figure out the money later," Ubel said.
There is a question whether later Congressional legislation will forgive debt incurred due to treatment of COVID-19, Ubel said.
"If you end up getting in debt from medical costs, don't pay it off. Just don't pay it off," Ubel said. "There will be a way. Either the hospital will forgive you, or there will be somebody who can advocate for you."
The Kaiser Family Foundation has more about options for people who've lost coverage.
SOURCES: Cheryl Fish-Parcham, M.S.W., director, access initiatives, Families USA; Peter Ubel, M.D., professor, business, public policy and medicine, Duke University, Durham, N.C.; Karen Pollitz, M.P.P., senior fellow, Kaiser Family Foundation; New York Times