Advice in this article is subject to change. Article was last updated 4/6/20.
What states currently have an SEP because of COVID-19?
As of 3/20, 11 states have announced limited-duration Special Enrollment Periods for individuals who don’t have insurance or are about to lose it due to COVID-19. DC is included because they have an ongoing SEP independent of the pandemic.
There has been no indication yet from CMS that an FFM SEP for individuals without a qualifying life event will happen. We will update the following summary table if that changes:
How does COVID-19 affect 2019 federal and state taxes for my clients?
On March 20th, Treasury Secretary Steven Mnuchin announced that the IRS’ tax filing deadline will be extended to July 15th. For now, this only applies to federal taxes.
State tax filing deadlines vary, and the American Institute of CPA’s is maintaining a list of state tax developments here.
If you have clients that still need to file their taxes, you are able to retrieve their Form 1095-A through your HealthSherpa Agent account. Please read here for more information.
Do Marketplace Health Plans cover COVID-19 testing?
The Families First Coronavirus Response Act (signed March 17th) included a health provisions section that lists entities that will cover testing for COVID-19 without imposing cost-sharing (e.g. deductibles, coinsurance, or copayments) for the duration of the public health emergency declared on 1/31/20.This coverage includes the cost of administering such approved tests and related visits to health care providers. Clients with Marketplace plans can expect this coverage. [1]
Do Marketplace Health Plans cover COVID-19 treatment?
Many health plans have publicly announced that they will be waiving any cost-sharing (including co-pays) that would otherwise apply to the test, as well as certain copays for treatment. America’s Health Insurance Plans is maintaining this list of how health insurers are responding to COVID-19.
You can find plan details in each client’s page through your HealthSherpa Agent account.
How will COVID-19 affect my client’s use of their essential health benefits?
Many health systems are already postponing non-urgent patient procedures, and they are changing in-person appointments to virtual ones. If your client is taking prescription drugs, please check the list form America’s Health Insurance Plans to see if an insurer is waiving early refill limits or providing delivery of all prescription medications free of charge.
What can I do to help my clients mitigate the costs associated with COVID-19 treatment?
This answer is most important for clients that see a specialist for a condition that makes them an at-risk group for COVID-19 complications (e.g. diabetes, cancer, COPD). Try to contact them soon and recommend that they reach out to their specialist to talk through what they should do if they contract coronavirus. The specialist may be able to admit your client to the hospital if he or she develops severe symptoms.
For your lower risk clients, we recommend walking through the costs that may be associated with COVID-19 emergency services. From the CDC, your patients should get immediate medical attention if they develop these emergency warning signs:
- Difficulty breathing or shortness of breath
- Persistent pain or pressure in the chest
- New confusion or inability to arouse
- Bluish lips or face
Otherwise, your client should call their doctor’s office or emergency room and describe their symptoms. They will tell your client what to do [2].
Which of my clients are at greatest risk for progressing to severe COVID-19?
From the CDC, possible risk factors include, but are not limited to, older age, and underlying chronic medical conditions such as lung disease, cancer, heart failure, cerebrovascular disease, renal disease, liver disease, diabetes, immunocompromising conditions, and pregnancy. [3]
This list is in no way exhaustive. If you have any suggestions of what can be added to this article, please share in the comments section below, or fill out this form to let us know what resources would be helpful.
Sources:
[1] https://www.congress.gov/bill/116th-congress/house-bill/6201/
[2] https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html
[3] https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html