Before the COVID-19 pandemic, 27.5 million Americans had no health insurance, but now, many more are at risk of losing their current coverage plans as businesses lay off workers because of COVID-19 precaution measures.
States, advocacy organizations and health care professionals are taking steps to ensure that the uninsured can still get testing and treatment in order to help slow the spread of the disease, but that hasn’t dissipated the confusion and worry that many may be feeling as case numbers rise across the U.S.
“If there are people who are not getting the screening, testing and treatment because of fear of a bill, that not only endangers themselves — that makes it much harder for the public health professionals to get a handle on the crisis overall,” said Anthony Wright, executive director of the California consumer advocacy group Health Access.
In addition to U.S. citizens who lack health insurance coverage, there are also millions of undocumented immigrants who are not eligible. Another 2 million people who live in the 14 states that did not expand Medicaid under the Affordable Care Act also fall into a coverage gap. They are not eligible for Medicaid, but are also ineligible for federal subsidies that make health insurance affordable through the national exchange.
“A crisis like this, where everyone is at risk and everyone can be affected, highlights the gaps in our health care system in a way that we don’t often see,” said Jennier Tolbert, associate director for the Kaiser Family Foundation’s program on Medicaid and the uninsured.
Here are some suggestions for uninsured people who are worried they may have COVID-19 and need help navigating the health care system.
If you’re sick, seek help
Even if someone does not have insurance, health care professionals say that anyone who fears they may have contracted the novel coronavirus needs to seek appropriate care.
“Hospitals are going to treat uninsured patients the same way they would treat any other patient. Their ability to pay is not going to be taken into account,” said Molly Smith, vice president of the coverage and state issues forum at the American Hospital Association.
Yet, if you’re uninsured, knowing where to turn can be tricky. Federal officials are telling people to contact their primary care physician to talk through their symptoms and for advice on whether they need to get tested for coronavirus, but people who don’t have health insurance tend not to have a primary care provider.
And health care providers have advised people who are already showing signs of having the virus to stay away from clinics or emergency departments, unless they have been advised to come in, or are having a medical emergency like severe difficulty breathing.
Health advocates encourage people who think they are sick to seek guidance from their respective state health departments.
Many local health departments have set up hotlines that can direct patients in the right direction. The Centers for Disease Control and Prevention also has an online “self checker” tool to guide patients to the best care.
Community health clinics, which serve vulnerable populations including low-income people, immigrants and the uninsured, are also available to help by addressing some symptoms, but many of them still don’t have the ability to test patients showing symptoms of COVID-19.
Sign up for health insurance
Some of the states that previously had not expanded Medicaid are now seeking ways to expand eligibility so they can temporarily insure more of their residents during the pandemic.
While open enrollment is typically limited to a few weeks in the fall, 11 other states and the District of Columbia are allowing residents a special period over the next few days and weeks to enroll in health care plans through state-run exchanges that were established through the Affordable Care Act. Insurance companies have been asking Congress to open up enrollment on the federal exchange as well.
Sign up for insurance quickly, but also to be careful to pick a high-quality plan, advocates are urging. They also advise Americans who are insured, but lack high-quality coverage, to consider upgrading their insurance plans.
Some states like California require all insurance plans to cover essential health benefits like coronavirus treatment, but that is not the case in all parts of the U.S. So patients who are signing up for insurance need to “beware of junk plans,” according to Caitlin Donovan, a spokesperson for the National Patient Advocate Foundation.
“We are afraid people are going to look for a short-term plan, buy it and then realize it doesn’t even cover coronavirus treatment,” she said.
For people signing up for insurance on the health exchanges, certified navigators at the state level can help guide people through which plan is best. Plans with lower premiums tend to have higher deductibles, but at least they provide some sort of cap on out-of-pocket expenses in case a person has to be in the hospital for days or weeks.
Free testing, but not treatment?
Congress has taken some steps to cut down on health care costs relating to COVID-19. A new federal law makes novel coronavirus testing free for patients without insurance, but it does not cover treatment related to the virus.
With hospitals already strained for resources, they say they need to be reimbursed quickly for treatments so that they can effectively fight the national health crisis, and health care groups are lobbying Congress to go beyond covering only testing.
Patient advocates argue that without federal assistance, people who have tested positive for the virus might still not get treatment because they know they could end up with crippling medical bills.
“If you are one of the people who gets COVID-19 and need to be on a ventilator for 10 days, that could result in a bill for tens of thousands of dollars,” Wright said. “For most people, that’s financial ruin.”
Many hospitals have charity care programs for low-income patients who can’t afford to pay full price for health care services. Some state and local governments also have programs to provide assistance for medical expenses.
Nonprofit groups often offer financial help for other needs as well, such as for rent or groceries, which are crucial for people struggling to make ends while many businesses remain closed.
“Your health isn’t just about your medical expenses; it’s about you as an entire person,” Donovan with the National Patient Advocate Foundation said. “People pay for their health care with the same bank account that they pay for everything else.”