UConn Law Professor John A. Cogan Jr. has an extensive background in health insurance law. Before joining the UConn Law faculty, he served as general counsel at the Rhode Island Office of the Health Insurance Commissioner and as Assistant Regional Counsel for the U.S. Department of Health and Human Services. He teaches courses on health law and health insurance. We asked him what Americans can expect from their health insurance plans as the coronavirus that causes Covid-19 spreads.
Should people with health insurance expect it to cover the cost of a coronavirus vaccination when one becomes available?
Perhaps. The Affordable Care Act makes vaccinations available to many Americans with no out-of-pocket spending—no copays, coinsurance, or a deductible payment for a vaccination. If a vaccine is developed and approved by the U.S. Centers for Disease Control and Prevention, then most Affordable Care Act health insurance plans will be required to cover coronavirus vaccination costs within a year of the CDC’s approval.
Adults covered by the Affordable Care Act’s Medicaid expansion would also receive vaccination coverage without cost to them. Children enrolled in Medicaid up to age 18 will also have coverage for vaccines through the Vaccines for Children program, which provides all CDC-approved vaccines without cost sharing.
Many folks with insurance, however, will not be covered for a coronavirus vaccination. Traditional Medicare (Parts A & B) do not cover a coronavirus vaccination. Medicare Advantage plans might cover a coronavirus vaccination, but it depends on the plan. Likewise, traditional Medicaid plans might cover a coronavirus vaccination for adults, but it depends on the state Medicaid plan. Non-ACA health insurance plans, such as short-term limited-duration plans, farm bureau plans, and Christian ministry plans, do not have to cover a coronavirus vaccination.
Will health insurance cover treatment and hospitalization for the coronavirus?
Public and private health plans will provide coverage for treatment and hospitalization related to coronavirus. The two biggest issues will be cost-sharing and charges by out-of-network providers. Most health insurance plans impose some cost-sharing (copays, coinsurance, or deductibles) for in-network providers. Plans that impose high out-of-pocket costs, such as a high deductible, will make coronavirus treatment very expensive for many Americans. (People may want to check their coverage. Most insurance companies now provide information about their coronavirus coverage on their websites.)
Patients can be charged for out-of-network costs when they receive care from a medical provider that is not in-network—that is, the provider has not agreed to a set fee with the patient’s insurance company. These out-of-network providers may charge the full amount for the treatment, and the insurance company may cover only some, or none, of these charges. Non-ACA plans, such as short-term limited-duration plans, farm bureau plans, and Christian ministry plans, may have limited coverage.
An estimated 9.4 percent of Americans are uninsured. Does that make the virus more dangerous here?
It could. To the extent that a lack of insurance coverage discourages or delays necessary treatment, uncovered Americans could face worse health outcomes than if they had coverage. Moreover, as uninsured patients seek treatment, hospitals and community health centers will face increasing financial pressures. As the virus spreads and intensifies, the federal government will have to cover these costs to avert the closure of struggling hospitals and health centers.
Are other countries with different health insurance systems better equipped to address this pandemic?
From a coverage standpoint, yes. By linking health insurance to employment, our system makes it harder to maintain coverage. Our coverage is also more expensive and often includes high deductibles that make medical care very costly.
What lessons do you expect the U.S. to learn from this pandemic? Do you expect this crisis to shift public opinion about our health care system?
Hard to say. Many Americans now favor more extensive, government-based health insurance coverage, such as Medicare-for-All. But these views are not universal; many Americans still oppose a government health insurance plan or a broad expansion of coverage. Given the uncertainty of the coronavirus, it is hard to predict how American public opinion will shift over the next few months.