- Hannah Huang is graduating this spring from the Weill Cornell/Sloan Kettering/Rockefeller MD-PhD Program; Noelle Sun is a graduate of the New England College of Optometry and a practicing optometrist in New York City.
- To protect yourselves and others at this time, they recommend getting insurance if you do not have it already and making a plan in case you or a loved one gets sick.
- There are a lot of insurance options to consider for low-income patients, but hospitals are offering options for those with COVID-19 who do not have coverage.
The COVID-19 pandemic has filled hospitals, moved clinics online, and changed the way we think about our health. If you are uninsured, you may wonder what to do if you or a family member becomes sick, especially if you do not have a family doctor and are trying to navigate the new policies that advertise free testing and treatment but contain gaps in coverage.
Here’s a quick guide to make a plan to implement immediately; many of these resources focus on New York City, but analogous resources are available in most places.
First, explore your health insurance options so that if you get sick you’ll be able to focus on your health and not on the costs. Next, regardless of whether you become insured, figure out your healthcare options so that you’re prepared the moment you or a loved one gets sick.
1. Before you get sick, explore health insurance options right now
Why is it important to consider insurance coverage? Having access to affordable healthcare protects both you and those around you. Studies have shown that people who do not have insurance tend to delay testing and treatment. In this pandemic, that means more people get sick.
To make matters worse, if you get sick, costs can add up quickly without insurance. A single hospital admission without insurance may cost $US10,000 to $US20,000, potentially even higher. In comparison, consider this example of insurance coverage for an individual living in Queens County:
Bronze plan ($US4225 deductible/$US8150 max out of pocket):$US437.42/moWith financial assistance for an income of $US30k/year: $US16.59/mo
Silver plan ($US1875 deductible/$US8150 max out of pocket):$US619.46/moWith financial assistance for an income of $US30k/year: $US198.63/mo
Enrolling in an insurance plan like these would cap the healthcare costs for which you are responsible and protect you and your family from medical debt if you become hospitalized.
There are several options for health insurance, and even ones that overlap.
Option 1:Find out if you are eligible for MedicaidIt’s available to those who have limited income, are disabled, or are unemployed. For example, a single individual in New York qualifies with an annual income of under $US17,609. A couple without children qualifies at $US23,792. State Medicaid contact information is available from this list.
Tip: Though the New York website (view the link on a desktop) says to contact the Human Resources Administration by calling (718) 557-1399, HRA is currently directing people to contact an enrollment specialist at (855) 355-5777. As wait times are long right now, it is best to call as soon as the line opens at 8 a.m. ET Monday through Friday.
Option 2: If you don’t qualify for Medicaid, find out if your state has temporarily reopened its health insurance enrollment period or if you qualify for a Special Enrollment Period (for example, due to job loss). This will allow you to sign up for insurance right now.
Currently, California, Colorado, Connecticut, Maryland, Massachusetts, New York, Vermont, and Washington are open until sometime between April 30th and June 30th. Find your state website through this portal.
Tip: Be sure to enter your income into the financial help calculator to see if you qualify for income-based assistance in lowering your premium. For example, if you make less than $US25,000 a year, you can enroll in a bronze level plan at no cost.
Option 3: If you are recently unemployed and lost your employer-covered health plan, you may qualify for COBRA coverage.COBRA allows you to keep the plan that you had prior to losing your job for a temporary period of up to 18 months. Note that you may be responsible for the entire cost of your insurance premium without your employer’s contribution. If you worked for an eligible workplace, your employer should provide you with application instructions within 14 days of job termination, and you have 60 days after termination to apply for it.
If COBRA doesn’t turn out to be an option, other options for newly unemployed individuals include Medicaid and the health insurance marketplaces (Options 1 and 2).
Once you are enrolled in insurance, there are a few key things you must do:
- Understand your insurance policy: including the costs that will be your responsibility and which providers are in your network.
- Establish a primary care physician: preferably over telehealth so that you can do it from home. Note that many practices are not accepting new patients at this time.
- Identify hospitals that are in your network: these are places that take your insurance. This way, you know where to go if you need it. Note that if you go to a hospital that is out-of-network, your out-of-pocket cost may be significantly higher.
2. Make a plan for if you get sick
Whether you get sick with COVID-19 or another illness, it’s important to have a plan in place so that you know where to go and what to expect.
If you are worried that you may have COVID-19:
Is testing and treatment free?It is important to seek testing and treatment if you think you have symptoms of COVID-19. Note, however, that the message that COVID-19 testing is free is oversimplified, and where you go to get tested will affect whether you have to pay. While federal funding of free testing to uninsured individuals is available for states, how and whether individual providers access this funding varies locally. In addition, patients may find themselves responsible for the costs of additional diagnostic tests and office visits where virus testing is not done. Even insured individuals may still be responsible for some out-of-pocket costs.
Note also that while the federal government has announced that part of the stimulus bill will go towards COVID-19 treatment for individuals who are not insured, the details are still being worked out. It is possible that parts of medical care or follow-up will not be covered; outpatient clinic visits and any non-COVID-19 care will also not be covered. For insured individuals, many major insurers are waiving some or all costs of treatment for COVID-19.
What if I have symptoms of COVID-19?If you develop symptoms such as fever, cough, or shortness of breath, the Centres for Disease Control and Prevention have released guidelines for steps to take if think you might have the coronavirus. Check your state’s COVID-19 website for local resources. In New York City, for example, more specific resources are available in this fact sheet.
Scenario 1: If you are uninsured or obtained insurance but have not established a primary care physician,call your local COVID-19 hotline (this site has a map with links to state hotlines and websites; the NYC Department of Health hotline is 1-888-364-3065). The hotline will be able to direct you to an appropriate testing or treatment site. Be sure to clarify whether the testing location they direct you to provides free testing. Note that some testing locations, such as urgent care clinics, may bill you for testing if you are uninsured or if they do not accept your insurance.
Scenario 2: If you were able to obtain insurance and establish care with a primary care physician, they will be your point of contact and will be able to order testing or direct you to a testing site if needed. Be sure to check your policy’s coverage for COVID-19 testing and treatment, as well as for related tests like X-rays, CT scans, and labs.
If you are sick for any reason:
If you have an emergency:Call 911 or go to your nearest emergency department. You will receive treatment regardless of your ability to pay. However, if there are multiple facilities near you, you may be able to minimise your costs if you research hospitals near you beforehand. Some may be more accommodating for those without insurance if you remain uninsured, and if you have insurance, you’ll want to know which ones are in your network.
Note that if you do end up in the hospital and your hospital stay is not covered by insurance, you may be eligible for Emergency Medicaid or financial assistant from the hospital.
If you are sick but it is not an emergency:Option 1: If you are an established patient, see if your primary care physician is providing telehealth services. Some clinics may be able to take new patients, but many, including clinics within New York City’s public health system, are currently unable to do so.Option 2: Consider a virtual urgent care visit. Many hospitals and urgent care walk-in clinics have recently added telemedicine services and are now providing virtual visits from your phone or computer. Hospital and clinic websites usually provide pricing information for patients not using insurance, though many insurances are accepted.
The following are some virtual visit locations available to those who live in New York City (prices noted without insurance):
- Mount Sinai: $US25
- New York Presbyterian: $US49
- Northwell Health: $US75
- NYU Langone: $US126 (plus additional fees if other services are provided)
Option 3: Some urgent care clinics are still offering in-person urgent care. For example, ExpressCare, which is part of NYC’s public hospital system, is open and operates on a sliding scale based on your income.
General tip: If cost is a factor, note that your visit costs may be affected by the physicians who see you, the procedures that are performed, and the medications that you are prescribed. Be sure to check what your insurance covers and mention your concerns to your healthcare team. They may be able to work with you to make a care plan that takes those concerns into account.
The US healthcare system is hard to navigate, but it might improve
The US healthcare system is expensive and difficult to navigate in the best of times. A pandemic makes it even more challenging, especially with policies that continue to evolve. For example, in New York State, Governor Andrew Cuomo recently announced a public-private hospital coordination to share resources and move patients across hospitals. While this policy is designed to help more patients get the care they need, it is not yet clear how this will affect insurance and billing, which is not uniform across hospitals. We will post updates here as we learn about them, but keep an eye out for local and national policy changes that could affect your medical plan.
Hopefully our experiences in the COVID-19 pandemic will inspire positive, durable changes in our healthcare system. Meanwhile, explore your insurance options, make a plan, and stay home when you can.
Hannah Huang is graduating this spring from the Weill Cornell/Sloan Kettering/Rockefeller MD-PhD Program. She is interested in delivering healthcare to underserved populations and was an executive co-director at the Weill Cornell Community Clinic, which serves uninsured individuals in New York City.
Noelle Sun is a graduate of the New England College of Optometry and a practicing optometrist in New York City. After witnessing many lose their jobs and health coverage due to the current pandemic, she wanted to help people navigate the health insurance system and understand the cost of being uninsured during this pandemic.
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