COVID-19 and My ACA or Medicare Health Plan
If you are wondering whether the COVID-19 test is covered by your individual health insurance plan. All ACA-compliant health insurance plans generally cover any Medically-Necessary (M-N) tests and/or procedures. The administration designated a new COVID-19 test as an Essential Health Benefit (EHB). EHBs are defined in the Affordable Care Act (ACA) as a set of benefits which individually purchased health insurance in the U.S and insurance plans in small group markets must cover (both inside and outside of the Health Insurance Marketplace). If you have individual health coverage OR have group health insurance, check with your carrier or employer for more details. The major change is that we may be seeing an easier path to accessing medical services. For example, many insurers are waiving Prior Authorizations for (M-N) diagnostic testing. Additionally, many insurers are not requiring member cost-sharing (co-payments and/or co-insurances) for (M-N) COVID-19 testing and services. Similar rules typically apply to Medicare and Medicaid beneficiaries. Also, many plans are encouraging Tele-Medicine services to reduce the strain on the doctor’s offices and hospital (and most at no co-pay). Although U.S. law requires that people who are truly sick get the emergency care they need regardless of ability to pay; it does not mean that you will leave with NO BILLS. Do you qualify for a Special Enrollment Period (SEP) to gain access to ACA-compliant health coverage? Short-term health plans and Christian Medi-share health plans may be options to help reduce Out-of-Pocket financial exposure.
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