Many people have already felt the ripple effects of COVID-19 on their finances — job loss, business closures, retirement funds or investment rates. But what about the cost of actually getting the virus? Testing, treatment and vaccines have to be paid for by someone. Hopefully, it’s mostly paid by your insurance. But there’s no simple answer.
A lot of price points will vary depending on whether you have insurance, who that insurer is, your insurance plan benefits, where you get testing or treatment and what state you live in.
The good news: Testing is mostly free
At this point, testing for COVID-19 should be free in most cases. The Families First Coronavirus Response Act (passed in March) provides funding to allow free testing and to cover costs for uninsured and undocumented people. If your test is run by the Centers for Disease Control and Prevention (CDC), state or city public health labs, the cost will be covered by the Department of Health (DOH).
For those with Medicare or Medicaid, tests are 100% covered. If you’re uninsured the testing cost is covered, but you could still receive a bill for any associated care. It’s best to be tested in public labs to ensure the DOH covers all costs.
A test completed by an academic or private lab usually costs $195. The lab will bill your insurance and federal law has required group and individual insurers to waive any cost for COVID testing that could fall on you. However, health insurance is full of loopholes and miscommunication. Your insurance plan might have a specific list of facilities approved for free testing and going elsewhere could incur out-of-pocket costs.
There may also be peripheral costs to getting testing for COVID-19. Because of limited testing kits and supplies, in some states you have to be prescribed the COVID-19 test by a doctor. This will likely mean running a series of other tests first. Going to the hospital to get tested could include charges like a hospital stay or any other virus or repository tests. Even if you have COVID symptoms, your doctor will likely want to rule out other illnesses first. You may be billed traditionally for those tests, especially if you test negative for coronavirus.
Though the new legislation prevents insurers from charging patients for COVID-19 testing, it doesn’t keep medical providers from doing so. It’s possible that you’ll get balance-billed, a charge from the medical facility that includes anything your insurance didn’t fully cover. If the facilities received federal funding from the CARES Act Provider Relief Fund, they are not allowed to balance-bill for COVID-19 testing or treatment. You also won’t be balance-billed if you go to a preferred provider. We recommend doing some research on the facility you plan to visit and the potential costs it could incur.
The bad news: Treatment costs are conditional
At this time, there is no official treatment or a specific cure for COVID-19. To treat the illness, health care workers are combatting the complications and symptoms using methods that treat similar illnesses (like pneumonia or the flu).
The treatment you receive, and thus any costs incurred, can vary widely depending on your symptoms. For some people, it might be similar to a mild flu while others may need more rigorous respiratory treatment.
Many who are infected won’t need to be hospitalized, and if your symptoms are mild (slight cough, mild fever) the World Health Organization (WHO) advises there’s no need to seek medical care. More severe COVID-19 treatment may include extended hospital stays (20+ days), scans, X-rays, fluids and IVs or ventilator support. The amount you pay will highly depend upon your insurance plan and the specific treatment you receive.
While the government has made proclamations that COVID testing will be covered, the same isn’t true for treatment. Insurers like Cigna, Aetna, Kaiser Permanente, UnitedHealth Group and Humana have announced they will waive some out-of-pocket costs for COVID-19 treatment.
The Kaiser Family Foundation’s Health System Tracker reported the average cost for similar treatment for pneumonia ranged from $11,533 to $24,178. With insurance the costs were lower, but out-of-pocket fees still averaged $1,300 to $1,464. If you’re uninsured, in a worst-case scenario your COVID-19 treatment bill could skyrocket to $75,000. Some states (Maryland, Massachusetts, Nevada, New York, Rhode Island and Washington) have new enrollment periods that would allow you to sign up mid-year.
There are a lot of loopholes and exceptions, insured or not. The specifics for self-funded employer plans will vary by company, for example. And if you test negative for COVID and instead have a flu with similar symptoms, you will be billed traditionally for any treatment. If you go out of network for treatment, you may also be billed for that. Even if the hospital is in-network but the doctor is considered out-of-network, you could be billed more.
More good news: The eventual vaccine is likely to be covered
A COVID-19 vaccine is in the works, but it’ll be quite some time until one is available to the public. Some states are thinking ahead and requiring coverage for future vaccines. Georgia, Iowa, Maine, Maryland, Massachusetts, Nevada, New Mexico, New York and Oregon are among states that have announced such measures.
Be proactive and stay informed
Health insurance is complicated and more measures are being announced every week. Research local policies, check which facilities near you are testing, and review your particular insurance policy. Don’t rush to pay a bill you receive if it doesn’t seem correct. Know there’s a good chance something will go wrong along the way, stay informed and advocate for yourself if any billing seems incorrect.
Visit our COVID-19 hub for more financial advice during the coronavirus pandemic.
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