The United States has been severely impacted by COVID-19, with almost 94 million Americans having been infected since early 2020. While most who contracted the virus have recovered, many are experiencing long-term effects that could adversely affect health insurance.
What is Long COVID?
Some Americans who have tested positive for COVID-19 can experience ongoing symptoms beyond the average person. These ongoing symptoms are referred to as Long COVID or post-COVID, and some studies have shown it can last up to a year. When someone contracts COVID-19 and has more severe symptoms, they are more likely to develop Long COVID.
According to the CDC, one-fifth of people with COVID-19 will experience at least one symptom, while global estimates suggest that 50% could experience Long COVID symptoms. According to Kaiser Family Foundation research, between 10 and 35 million adults could be affected.
Not only does having Long COVID mean more symptoms, more extended periods of time off work, and just a general feeling of being sick, but it can rack up some major medical expenses. If you have Long COVID, you may wonder if your health insurance will cover these medical expenses, and if so, for how long.
Common Long COVID Symptoms
It can be challenging to determine for sure if someone has Long COVID. Because symptoms vary from person to person, you must consult your doctor if you feel you may have it. Some symptoms associated with this disease include malaise, fatigue, breathing challenges, migraines, cardiovascular problems, and mental health issues.
Those who may have Long COVID could be unable to work for several months because of the developing symptoms. After getting Long COVID, 25% of adults who had worked before the infection were out of work, and 31% reduced their hours, making them ineligible for full-time benefits.
Additionally, more than 60% of adults receive health insurance through their employers. If a person with a long COVID cannot work, they could lose their existing coverage and income. If you are worried about losing your benefits, talk to your doctor.
What Treatments Exist For Long COVID?
The treatment options for Long COVID vary based on symptoms. When you visit your doctor and discuss your symptoms, they will develop a treatment plan tailored to your needs. Depending on your symptoms, you may have to see a specialist. Some have had to see a cardiologist, neurologist, psychologist, pulmonologist, infectious disease specialist, psychiatrist, or rheumatologist.
While there is currently no specific medication to treat Long COVID, your doctor may put you on different options to treat the symptoms. The goal at this stage would be to increase your quality of life. The COVID vaccine may or may not help reduce symptoms.
Does Health Insurance Cover Long COVID?
Because researchers are still learning about the effects of Long COVID, there is not a black-and-white answer to whether health insurance covers it. The determination will be based on the type of doctor you need and your treatment. Typically, you should have some level of coverage through your health insurance policy.
Traditional Health Insurance
If you have traditional health insurance that is ACA compliant, the 10 essential benefits are covered, meaning many treatment options for Long Covid will be covered. Remember that you still have a deductible and co-insurance or co-pays as applicable.
Also, be cognizant of whether the doctors you see are in-network because that will affect your coverage. A traditional health insurance plan through your employer or the ACA will cover inpatient and outpatient care, prescription drugs, mental health care, and rehabilitative services.
Your plan will also have an out-of-pocket maximum which is essential to pay attention to. Long COVID could mean long-term treatment, so if you reach your out-of-pocket maximum for the year, your health insurance will kick in and pay for the rest after that until the new year.
Under the Affordable Care Act, Medicaid must also cover the 10 essential health benefits. While Medicaid benefits vary from state to state, in general, Medicaid coverage is robust, and out-of-pocket costs are low. Long COVID diagnosis and treatment should be covered after you meet your deductible and after any other cost-sharing requirements on your policy.
Your coverage for Long COVID treatment should be covered if you have Medicare, and those with supplemental plans, or Medigap, should have lower out-of-pocket costs. Depending on how you access your benefits, your medical providers and out-of-pocket costs could vary. Be sure to check your policy before seeking care.
Short-term Health Insurance
Since the ACA does not regulate short-term health insurance, you could run into some issues with coverage for the treatment of Long COVID. There are a lot of exclusions usually found in a short-term health insurance policy and usually exclude pre-existing conditions, so COVID-19 could be considered one if you had it.
Can an Insurance Carrier Deny Coverage for Long COVID?
Regardless of the claim, you will submit it to your health insurance carrier, and it will need to be reviewed to determine if coverage is available. If your policy has exclusions, the claim could be denied. Luckily, most plans purchased in the United States are governed by the ACA and cannot exclude pre-existing conditions, which would be the biggest reason for the denial of the claim.
What To Do If You’re Denied Coverage
If your insurer has denied coverage, you can submit an appeal. If your plan is not considered grandfathered, the Affordable Care Act allows you the option to appeal any claim that is denied. If you have Long COVID or are concerned about developing it based on your COVID-19 symptoms, you should have an ACA-compliant plan.
Remember, even if your claim is not denied and coverage is available, you will likely have some out-of-pocket costs. This may include a deductible, co-insurance, and co-pays. You will want to read your policy to understand the costs you may have to endure.