Posts

Insurance Coverage and Coronavirus Testing

Will My Insurance Cover the Cost of Coronavirus Testing?

As we continue to navigate through the effects of COVID-19, many questions arise when it comes to insurance coverage. Does your specific insurance cover testing? Does it cover treatment? How can I find out my coverage options? 

The short answer is it depends on your coverage. Health insurance coverage varies widely, depending on where you live and how you obtain your coverage. Almost half of Americans receive their insurance coverage from their employers. Those plans are managed by both the federal and state guidelines, which depend on the group size and whether or not the plans are self-insured or fully-insured. So how does Coronavirus coverage fit into these health plans?

Let’s begin with testing. The Families First Coronavirus Response Act states the Medicare, Medicaid, and private health insurance plans are required to cover the cost of Coronavirus testing, without cost-sharing or pre-authorization requirements. This is including lab service costs and provider fees at doctor’s offices, urgent care clinics, and emergency rooms where tests are given. Because this act is federal law, self-insured and fully-insured plans apply to this rule. However, the testing coverage requirements that are imposed on some states are only applicable to fully-insured plans.

Plans that are not considered minimum essential coverage, for example short-term health plans, fixed indemnity plans, and healthcare sharing ministry plans, are not required to cover COVID-19 testing. Some of these plans do volunteer to cover COVID-19 testing, so look to your plan for specifics.

Some states, like Washington, have extended their testing coverage requirements to include these short-term plans, but most states have not imposed further requirements for these plans.

If you are uninsured, states can use their Medicaid programs to cover COVID-19 testing to cover their uninsured residents. There is $1 billion in federal funding to reimburse providers to cover COVID-19 testing for uninsured patients.

Now, let’s get into treatment coverage. As of right now, there is no specific treatment for COVID-19, most people will not need treatment, but around 20% of patients will be hospitalized, and 20% of those patients will need intensive care. This inpatient care is considered an essential health benefit for all ACA-compliant individual and small group health plans. Large group plans are technically not required to cover essential health benefits, but they are required to provide “substantial” coverage for inpatient care.

Even with coverage, inpatient care is expensive. The ACA states that all non-grandfathered/grandmothered plans must have in-network out-of-pocket maximums that can reach up to $8,150 for a single individual. Most COVID-19 treatment costs will not exceed this amount, but many health plans out-of-pocket limits are below that amount. Which leaves patients that need hospitalization with a four-figure invoice.

Some states, like New Mexico and Massachusetts have required state-regulated insurers to cover treatment and testing without cost-sharing. Minnesota is encouraging their providers to do the same. 

Most states are both encouraging and requiring state-regulated providers to allow testing and treatment as in-network, whether or not the medical providers are in the plan’s network. Patients may still be subject to balance billing because out-of-network providers do not need to accept the payment as payment-in-full.

Here are some ways to ensure that you are protected during these uncertain times:

  • If you are uninsured there is a COVID-19 special enrollment period in some states. If your state is included, an ACA-compliant plan is a great option. If you have a low income, you could also be eligible for Medicaid.
  • If you currently have health insurance, understand what your plan covers, and how your cost-sharing responsibilities for in-patient and out-patient care may apply.
  • Look at your health plan to see how it handles prior authorizations.
  • Look at the details of your health plan’s provider network. If you see in-network providers you have a better chance of avoiding balance billing.
  • Check to see if telehealth is covered, for less-severe cases, this is the best way to help prevent the spread of COVID-19. Some health plans are eliminating or reducing cost-sharing for telehealth services.
  • If you have an HSA-qualified plan, you can devote your pre-tax money to your account for the year. The money you contribute to your plan is able to be withdrawn tax-free for out-of-pocket health care expenses.

Virtual Care and the Telemedicine Revolution

During this time of uncertainty, there has been an increase in consumer demand for virtual healthcare services, which has put added pressure on providers and payers to expand delivery options for on-demand health services.

A survey from Accenture, which included 1,501 consumers who answered questions online, found that most people are willing to utilize virtual healthcare services. For the 20% of respondents who had received care virtually, the reasons they cited most often for seeking virtual care are:

  • Greater convenience than traditional in-person healthcare services (37%)
  • Familiarity using technology to manage their health (34%)
  • Curiosity to try virtual health (34%)

Consumers said they would be more likely to “try virtual” if encouraged by a physician or familiar healthcare provider.
According to the research, today’s consumers are demanding a combination of in-person and virtual health services. More than 75% of those surveyed said they would be interested in receiving healthcare virtually some or most of the time.

What is Virtual Health?

Virtual health includes health care innovations like virtual appointment kiosks and portals, remote consultations, and electronic personal health records. These components work together to allow for easier access to care, such as virtual wellness coaching, remote monitoring, video visits, and online health chats, among several other benefits that we will examine more closely below.
Virtual health combines clinical care and professional collaboration through telemedicine, telehealth, and collaboration at-a-distance to connect clinicians, patients, care teams, and health professionals to provide health services, support patient self-management, and coordinate care across the care continuum.
Specific to physician-patient encounters, virtual health enables live and asynchronous clinical interactions, clinical practice, and patient management supported by a wide range of communication, collaboration, and cognitive computing technologies along with digital devices and data.


Benefits of Virtual Health and Telemedicine

As you can see, there are many benefits of offering Virtual Health. For patients and medical practices, the use of telemedicine technology allows patients to receive follow up care and chronic illness management from their own home on the devices they already own and use. This follow-up care is especially crucial for those who are homebound or have difficulty arranging travel.
For healthier patients, it reduces travel time and costs and requires less time away from work. As an added benefit, patients do not have exposure to other potentially contagious patients. In short, telemedicine removes many of the barriers preventing people from actively managing their health.

Here are the main benefits for most patients:

Improved Access – Not only does telemedicine improve access to patients, but it also allows physicians and health facilities to expand their reach beyond their own offices. Telemedicine has a unique capacity to increase service to millions of new patients.

Cost Efficiencies – Telemedicine has been shown to reduce the cost of healthcare and increase efficiency through better management of chronic diseases, shared health professional staffing, reduced travel times, and fewer or shorter hospital stays.

Improved Quality – Studies have consistently shown that the quality of healthcare services delivered via telemedicine are as good those given in traditional in-person consultations.

Virtual Health Care technology is excellent for providers as well. It can help extend clinical services to reach more patients efficiently and profitably. It helps improve health outcomes by increasing patient compliance with follow up and chronic illness management. Virtual Health Care strengthens patient relationships without putting additional strain on the medical staff.
There are significant benefits to medical practice, as well. By utilizing virtual health, your practice can expand access to care. It improves clinical workflows by helping your staff capture each patient’s reason for the call or visit quickly, prioritize care delivery, suggest the best treatment guidelines, and identify additional information resources. Virtual health care can also support communication along the care continuum.

What does this mean for my practice?

Technology is providing new methods to assist your clients by responding to the need for better communication. It’s also creating a competitive landscape the medical field has never seen before. Embracing this new trend will enable you to maintain your patients for years to come.

Contact SBMA for more information on employee benefits packages that include virtual health services!

What Exactly is Telemedicine?

Healthcare providers have been offering remote services for years, which have allowed patients to receive healthcare from the comfort of their own homes. Before the recent advancements in technology, these remote services were done over landline phones. Now patients can see their doctors at their office using various online platforms, including Zoom and Skype. So what exactly does telemedicine entail? 

Using telemedicine, you can discuss symptoms, medical issues, receive a diagnosis, learn treatment options, and get prescriptions. There are a few common types of telemedicine which include:

  • Interactive Medicine: This involved a physician and patient communicating in real-time. 
  • Remote Patient Monitoring: This gives caregivers the ability to monitor specific patients who have medical equipment that collects information like blood pressure, blood sugar levels, and more.
  • Store and Forward: This type of telemedicine allows providers to share their patient’s information with other healthcare specialists and professionals.

While they sound the same, there are a few critical differences between telemedicine and telehealth. Telemedicine, as stated by the World Health Organization, is “healing from a distance.” You receive treatment without an appointment or visiting the office. Telehealth uses electronic information to support long-distance clinical healthcare, education, and administrative activities. It improves patient care and physician education rather than providing a service. It involves scheduling appointments, medical education continuation, and training for physicians.

When should you use telemedicine? Telemedicine is not for emergencies. Anything that requires urgent, primary care, you should go to a doctor in-person. However, telemedicine is for straight-forward questions and issues, and any follow-up consults. It also can be helpful with psychotherapy and teledermatology. Some examples of straight-forward issues include cold and flu symptoms, insect bites, diarrhea, pink eye, and sore throats.

Telemedicine has advanced our current health care options by offering several new benefits. It is making healthcare accessible for more patients, whether they live in a remote location, have a packed schedule, or any other number of other reasons. 

Telemedicine is also much more financially accessible. A recent study found that the average telemedicine visit is around $79, whereas an average doctor’s appointment is $149, and a trip to the emergency room costs, on average, $1,734. As telemedicine continues to grow, health insurance providers are offerings coverage for telemedicine visits. Some states even require that health insurance plans reimburse patients for telemedicine visits. 

Telemedicine offers a more accessible opportunity for healthcare and changing the way we visit the doctor. At SBMA we offer the most competitive limited benefit plans in the industry, including virtual health options! Check out our services for more information!

Health Insurance Options for Coronavirus Job Loss

As COVID-19 continues to impact our daily lives, unemployment has reached a record high, jumping to 14.7% as of April 2020. There are many things to consider when assessing these new statistics and, as an employer or an employee, it’s important to ask yourself this question: What health insurance options are there for those that have experienced job loss due to Coronavirus?

If you’ve lost your job due to Coronavirus or have experienced a reduction in hours, here’s what you can do:

If you’ve lost your health plan through your job you may qualify for a Special Enrollment Period. If you have lost your coverage within the past 60 days, or you expect to lose coverage in the next 60 days, you are also eligible for a Special Enrollment Period. 

If you have experienced a reduction of hours and are part of a Marketplace plan, you should update your application to report any household income changes within 30 days. This may lead to more savings than you’re getting now.

If you have experienced a furlough, depending on the status of your coverage, you might be eligible for a Special Enrollment Period. You might also qualify for a premium tax credit to assist your Marketplace coverage payment.

For people with COBRA continuation coverage, you may be able to qualify for the Special Enrollment Period. Based on your pre-COBRA coverage, you have 60 days to enroll in Marketplace coverage. You may also qualify for premium tax credits, only if you end your COBRA continuation coverage. 

If you have lost your job, but your company did not offer coverage, you typically do not qualify for a Special Enrollment Period. Job loss on its own does not make you eligible for a Special Enrollment Period.

If you are unable to pay your insurance premiums due to Coronavirus there are some things to consider: First, check with your insurance providers to see about extensions. Usually, there is a grace period determined by state law. If you receive financial assistance with your premiums, there is a three-month grace period where your plan cannot be terminated for failure to pay premiums. 

If you know that you qualified for a Special Enrollment Period, but missed the deadline due to Coronavirus impact, there is a chance you can be eligible for another Special Enrollment Period. 

As employers continue to understand how to effectively run their businesses throughout Coronavirus, we want to help you understand how to remain covered and safe. Here is a list of our COVID-19 resources that may be helpful as you work to understand what’s next for you and your company.