COVID Health Lifeline

Leer en español

 

The Families First Coronavirus Response Act (FFCRA), the Coronavirus Aid, Relief, and Economic Security Act (CARES), and NYS Insurance Laws provide that insurance plans must cover testing and preventative services relating to the COVID-19 public health emergency. These laws also provide guidance regarding health insurance coverage of emergency services in accordance with NYS law.

 

What if I have a private insurance plan?

Generally, private health insurance plans must cover testing and provide free coverage of any qualifying COVID-19 related prevention services (including a vaccine) during the public health emergency, which was declared on January 31, 2020 and is still in effect at this time. Private health insurance plans are not allowed to charge deductibles, coinsurance, or copayments for approved tests or related visits to health care providers. FFCRA and CARES laws only provide for coverage of testing and certain prevention services relating to COVID-19, not treatment.  Your insurance plan may cover COVID-19 treatment like any other illness, but it is not required to waive the co-pay, deductible, or coinsurance.  You should check directly with your plan about co-pays or other cost-sharing.

You can find information regarding the FFCRA Act here. You can find information regarding the CARES Act here.

I have Medicare. Am I still covered under this law?

Medicare and Medicare Advantage (MA) plans must cover visits to health care providers that relate to COVID-19 testing during the public health emergency, which was declared on January 31, 2020 and is still in effect at this time. MA plans are not allowed to charge deductibles, coinsurance, or copayments for these visits. MA plans are also not allowed to require a referral, or other pre-treatment requirements, from a primary care doctor for testing. FFCRA and CARES laws only provide for coverage of testing and certain prevention services relating to COVID-19, not treatment. Your plan may cover COVID-19 treatment like any other illness, but it is not required to waive the co-pay, deductible, or coinsurance.  You should check directly with your plan about co-pays or other cost-sharing.

You can find information regarding the FFCRA Act here. You can find information regarding the CARES Act here.

Am I covered if I have Medicaid or Children’s Health Insurance Program (CHIP)?

COVID-19 testing and related prevention visits must be covered without deductibles, coinsurance, or copayments, under the Children’s Health Insurance Program (CHIP) and Medicaid during the public health emergency, which was declared on January 31, 2020 and is still in effect. FFCRA and CARES laws only provide for coverage of testing and certain prevention services relating to COVID-19, not treatment.  Your plan may cover COVID-19 treatment like any other illness, but it is not required to waive the co-pay, deductible, or coinsurance.  You should check directly with your plan about co-pays or other cost-sharing.

 

You can find information regarding the FFCRA Act here. You can find information regarding the CARES Act here.

FFCRA and CARES laws only provide for coverage of testing and certain prevention services relating to COVID-19, not treatment. Your insurance plan may cover COVID-19 treatment like any other illness, but it is not required to waive the co-pay, deductible, or coinsurance.  You should check directly with your plan about co-pays or other cost-sharing.

 

If you do not have health insurance, you and your family may be eligible for a low-cost health plan, Medicaid, or Child Health Plus.  If you enroll between March 15 and April 15, your coverage will start on April 1.  If you need help, contact a certified navigator.

Is the cost of an in-network provider visit covered if I need to be tested for COVID-19?

Deductibles, coinsurance, or copayments for COVID-19 laboratory tests are waived so that it is easier to get tested. Also, deductibles, coinsurance, or copayments for an in-network provider office visit and an in-network urgent care center visit are waived when testing for COVID-19.

Insurance issuers must allow for out-of-network treatment at the in-network deductible, coinsurance, or copayment rate if there are not enough in-network providers to handle the increased need for COVID-19 health services in New York.

For more information, please see NYS Department of Financial Services (DFS) Insurance Circular Letter No. 3 (2020).

What if I need to seek emergency care due to COVID-19?

Generally, insurance policies and contracts must cover services to treat an emergency condition in hospital facilities.  Also, insurance plans offering individual and small group policies and contracts must provide worldwide coverage for emergency services in hospital facilities. Insurance plans offering large group comprehensive health insurance policies and contracts must cover emergency services in hospital facilities in the United States, its possessions, and the countries of Mexico and Canada.

In addition, insurance plans cannot require that you get a referral for emergency care, treatment or admission from your primary care doctor.  However, if you are admitted to the hospital for COVID-19 treatment, your insurance plan is not required to waive the co-pay, deductible, or coinsurance.  You should check directly with your plan about co-pays or other cost-sharing.

For more information, please see NYS Department of Financial Services (DFS) Insurance Circular Letter No. 3 (2020).