Jena Starkes is pretty realistic about the challenges she faces when confronting COVID-19: it could get rough. The 45-year-old lives with her 81-year-old mother in Brooklyn, and in recent days, as the outbreak has worsened, she felt there was not much they could do.
“If I get it and I give it to her, it is unlikely that she would survive,” Starkes says. But, she adds, because she doesn’t have insurance for herself — and can’t afford out-of-pocket hospitalization — her own health is hardly secure either.
“If I get it bad, I would probably just die,” she says. “What if I had to be ventilated? What if I had to pay $300 for a test? I literally could not.”
Starkes is trying to be careful about social distancing so she doesn’t get her mother sick, but her concerns are real. She owns her own web design business and she can’t afford to pay for an individual insurance plan, and while her mother’s Medicare covers some costs, the co-pays are a strain. “On a normal day, there is no system. There’s no way for me to get to go to a doctor for a reasonable cost,” Starkes says. “We are barely making our rent as it is.”
On March 18, Congress attempted to address some of Starkes’ problems by passing the Families First Coronavirus Response Act. But there are a number of ways the bill fails to protect people like her. It offers limited provisions on paid sick leave and unemployment insurance, but it does not address the cost of actually being treated for the virus. And while it supposedly made getting tested for the coronavirus free, it probably won’t always work out that way.
“That’s nice,” Starkes says of the new law, “but we’re all still in the same boat.”
Here is what you need to know about getting tested for COVID-19.
How much will getting tested cost me?
It’s supposed to be free. The new law mandates that Medicare, Medicaid, other government plans, and most private plans cover COVID-19 testing — and all testing-related services — entirely. That means no co-pays, no deductibles, no co-insurance charges.
But beware. Our health care system is a mess and the law does not explicitly prohibit charging you if you go to an out-of-network provider. It also doesn’t address other “surprise billing” problems.
The law requires insurers to cover testing and doctor’s office, urgent care, telehealth or emergency room visits as long as the services “relate to the furnishing or administration” of a COVID-19 test or “to the evaluation of such individual for purposes of determining the need” of a test. That means that if your visit does not result in a COVID-19 test, if you get tested somewhere that is not in your insurance plan’s network, or if you’re treated in anyway besides just getting a test, you could end up with a bill.
“When your health plan has to cover [testing], that just means the health plan has to cover what it would say is a reasonable charge,” explains Karen Pollitz, a senior fellow at the nonpartisan Kaiser Family Foundation. “The difference between what your health plan thinks is reasonable and what the provider bills you, that’s on you.”
The law also only covers testing starting the day it was enacted, March 18. So if you got tested before then, this will not apply to those services.
You should theoretically still be able to get tested for free. The March 18 law offers two solutions. The first is that it gives $1 billion to the National Disaster Medical System to reimburse medical providers for testing and diagnosing uninsured patients. That means that medical providers would be able to submit your bill directly to the federal government and get reimbursed without you having to be involved.
The other solution is that the law boosts funding for Medicaid and allows states to choose to cover uninsured residents’ testing for free through that program — meaning you would be temporarily enrolled in your state’s Medicaid program for the purposes of being tested.
People like Starkes should be able to take advantage of these provisions to get a free COVID-19 test, but there’s still the chance that she could end up with charges the government considers not directly related to the test.
Before Congress passed the new law, a number of states started acting to cover COVID-19 testing and other services. Many of these measures apply only to people with health insurance, but Maryland, Massachusetts, Nevada, New York, Rhode Island and Washington have all created “special enrollment periods” that allow people to sign up for insurance mid-year. The Commonwealth Fund, a health care think tank, has a tracker listing each state’s actions to help its residents with the COVID-19 outbreak.
For some portion of the more than 27 million Americans like Starkes, who are uninsured — and the many others who are underinsured — that’s not much of a boon. Starkes says she couldn’t afford to buy health insurance prior to the coronavirus pandemic. Now that the economy is grinding to a halt, she’s in no better position to pony up a large premium every month.
The work for her web design business can largely be done remotely, but as many businesses close amid the pandemic, it may get more difficult to find people to hire her. Starkes’ mother has also stopped earning money from her part-time job with New York City’s Teaching Fellows program since the city shut down its schools due to the virus, and won’t make more unless they figure out a remote learning setup.
“There’s an awful lot of ex-middle class people like me, who have slipped under the radar, who make way too much money to qualify for government assistance, and yet absolutely cannot pay the ‘affordable’ insurance costs every month,” says Starkes. “That sucks. But that’s America. That’s who we are.”
Abigail Abrams at abigail.abrams.