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En español | More Americans are testing positive for the coronavirus every day — a trend experts predict will continue in the coming weeks. And with confirmed cases of illness in all 50 states and the District of Columbia, many are left asking: Who's going to pay for my care if I test positive?
The answer: It depends on your insurance, and experts encourage individuals with questions about coronavirus coverage to contact their health plans.
More than 170 million Americans are covered by private health plans, according to the Kaiser Family Foundation (KFF), and 60 million are on Medicare. Just as with any illness, “the cost to the consumer will be based on the design of their health plan,” explains Sara Collins, vice president for health care coverage and access at the Commonwealth Fund, a health research foundation.
"It's just a lot of variation by state, by health plans, and I think that people will be somewhat confused, as usual, about what is included in their plan and what the out-of-pocket costs might be to them,” she adds.
Testing fees covered, but doctor's visit usually isn't free
Several private insurers last week announced plans to waive cost sharing for coronavirus testing. Medicare officials also said that its beneficiaries do not have to pay out of pocket for a coronavirus test.
But as tests begin to be conducted in private labs and doctors’ offices, patients may start seeing bills — not for the actual test, but for the visit to the doctor's office to get a nasal swab.
The “challenging aspect of this” is that an increasing number of Americans have high-deductible health plans, where the policyholder pays a certain amount out of pocket for health care before insurance coverage kicks in, says Nadereh Pourat, a professor of health policy and management at the UCLA Fielding School of Public Health.
The average deductible for a person with employer-based coverage was $1,655 in 2019. People with non-group plans paid, on average, more than $4,500 to meet their plan's deductible that same year, according to KFF.
"If you have a high-deductible [plan] or you don't have money, it's going to prevent some people from seeking care, like any other illness — except this one has very different consequences,” Pourat says.
New legislation, however, could change this. The U.S. Senate on Wednesday approved a bill that would require health insurers to cover COVID-19 testing and related services — costs associated with the visit to a physician’s office, urgent care facility or emergency room — without cost sharing. COVID-19 is the illness caused by the current coronavirus.
"We would rather not be in a situation where people are hesitant to contact the health system because they're worried about how much it's going to cost them,” says the Commonwealth Fund's Collins. “We want people to get care and to be able to call their physician without having to incur a cost.”
Out-of-pocket spending for treatment could cost thousands
The majority of people with COVID-19 experience mild symptoms that can be treated at home with over-the-counter medications to lower fever and suppress cough. But severe cases — more common in older adults and people with underlying health conditions — may require hospitalization.
And just like the charges associated with a visit to a doctor's office, the cost of a hospital stay depends on an individual's insurance plan and any copays, coinsurance and deductibles.
A new analysis from the Peterson Center on Healthcare and KFF found that the cost of treatment for severe cases of COVID-19 could top $20,000, and that people with insurance could face out-of-pocket costs exceeding $1,300.
There's also the possibility of surprise bills from out-of-network health care providers. It's not unusual for hospitals in a policyholder's network to use staff and labs that are not included in some insurance networks.
"It's important to point out that about 30 million people don't have health insurance at all,” Collins says. For these individuals, care for a serious case of COVID-19 is simply unaffordable.
"There's lots of research that shows that people make decisions that aren't always in their best interest in terms of their health if they face a lot of cost sharing,” Collins adds.