What You Should Know About Coronavirus Medical Coverage in NYC

As the country grapples with the consequences of the global coronavirus pandemic, there is growing apprehension about the costs associated with testing and treating COVID-19. Policies concerning out-of-pocket costs related to coronavirus testing and treatment are rapidly evolving at the federal and state levels. There is general uncertainty among the public about who would bear the costs for any medical expenses related to coronavirus, particularly for testing and/or treatment. As of March 2, 2020, New Yorkers who receive Medicaid coverage and/or Medicare Part B will have all costs related to testing for COVID-19 covered when a doctor or other health care provider orders the test. People with employment-based and individual insurance plans will not be required to pay copays when visiting in-network providers, urgent care or emergency rooms to be tested for COVID-19. While coronavirus tests are now free in New York State for Medicaid and Medicare Part B recipients and individuals with employer-based/individual insurance plans who visit in-network providers, insureds might still incur cost-sharing for coronavirus testing when visiting out-of-network providers and when receiving in and out-of-network treatment.

As federal lawmakers continue to negotiate legislation that could potentially address out-of-pocket spending related to testing and treating COVID-19, it is important to prepare in the event you or a loved one gets sick with coronavirus. While testing is generally covered regardless of your insurance, if you test positive and need hospital care, you might still have to pay a share of the cost for coronavirus treatment depending on which insurance plan(s) you have. For example, Aetna, one of the nation’s largest insurance companies, recently waived cost-sharing for inpatient hospital admission related to coronavirus at in-network facilities for many policyholders. Therefore, it is important that you contact your insurer(s) to understand the in-network and out-of-network premium, deductible, coinsurance, co-pay and maximum out-of-pocket costs that could be incurred for COVID-19 treatment based on your insurance policy. In summary, if your doctor orders the test and you stay in-network, testing costs will probably be fully covered. However, if the test is positive and you need treatment it may not be fully covered, so try to use only doctors and facilities within your network to keep your share of any treatment costs to a minimum.

If you suspect you have the coronavirus, call your insurer(s) before being tested (if possible) and confirm that the lab that will administer the test is in-network and that the procedure will be covered by your insurance. If you or a loved one need urgent care or an emergency room visit to be tested for coronavirus, contact your insurer within 24 hours of being admitted or have someone ready to do that for you in the event that you cannot do it yourself.

 Even if the hospital where you are receiving treatment is in-network, you could receive care from a doctor or anesthesiologist who is out-of-network. In order to avoid surprise medical bills, tell your doctor(s) that you want to stay in-network throughout your treatment and have your request put in your records.

Make sure you keep every letter, authorization, medical bill, and denial that you receive from doctors and the hospital, and request an itemized bill from the hospital. These documents could be useful in the event that you want to dispute or negotiate a medical bill.

If you or a loved one are a cancer patient or survivor and are struggling with medical debt related to coronavirus or other medical conditions, please contact the Cancer Advocacy Project at 212-382-4785 for more information and resources on dealing with medical debt.

Vivienne Duncan is the Project Director of the Cancer Advocacy and Elderlaw Projects. Alexa Tovar is the Project Coordinator of both projects.