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Numi Lee Griffith
High Value Health Care, Advocate

Author: Numi Lee Griffith

High Value Health Care, Advocate

Started on staff: 2018
B.A., University of Puget Sound; J.D., University of Colorado, Boulder

Numi runs OSPIRG’s health care campaigns, working to control the skyrocketing cost of prescription drugs and ensure Oregonians receive the high-quality health care for their dollar. Before joining staff, Numi worked as an attorney in private practice, focusing on consumer rights, real estate and intellectual property law. When she isn’t working, you can usually find Numi at one of Portland’s many rock climbing gyms or coffee shops. 

The novel Coronavirus, and COVID-19, the disease it causes, have been dominating headlines in the United States and around the world for nearly three months.  Over the last few weeks, as COVID-19 was designated a pandemic by the World Health Organization and cities and states have taken steps to slow the spread of the disease, most Oregonians have felt the effects of COVID-19 in their own lives.

OSPIRG Foundation has prepared this guide to help you understand how you can get health coverage if you’re at risk of losing employer sponsored insurance, what special protections have been created for insured consumers in Oregon, what insurance coverage can help you with during the outbreak, and what benefits are available to all Oregonians under emergency measures.  Read on to learn more about:

New Protections for Consumers who Have Current Health Coverage

If you have current health insurance coverage and have not been laid-off, whether you have purchased it individually or have group coverage through your employer, the State of Oregon and some private insurance companies have introduced new protections in light of the COVID-19 outbreak.  Here’s some of the new benefits you can expect if your coverage has not changed, or if you have bought into a new private plan.

  • Coverage for Coronavirus testing: under the coronavirus relief bills passed by Congress, all Americans with all forms of health insurance coverage will not have to pay out-of-pocket costs for Coronavirus diagnostic testing, or costs associated with a medical visit made for the purpose of coronavirus testing.

  • Coverage for Coronavirus treatment: several major private insurers, including Cigna, Humana, Aetna, and United Health have agreed to waive out-of-pocket costs for treatment of the novel coronavirus.  However, none of the new relief laws require this coverage, so you should check with your insurer for more specific information. 

  • Telemedicine: for the duration of social distancing restrictions, the state expects all insurers to cover remote medical visits via phone or video calls just as they would cover similar in-person services.  Many regular medical visits can be completed through remote communications. Requiring coverage for telemedicine will allow Oregonians to continue most of their regular medical care while minimizing the risk of coronavirus exposure to health professionals.

  • Continuing Coverage: all insurers must take steps immediately to suspend all cancellations & renewals of active policies for the duration of the crisis.   With these protections, you will not lose your existing coverage or need to renew as the result of a non-payment.

  • Premium Payments: insurers must extend all grace periods for non-payment of premiums, and give consumers the ability to make premium payments while maintaining safe social distancing.  Even though you are now protected from a loss of coverage, you will ultimately need to catch up with your premiums after the crisis ends. These protections give you additional time to pay your premiums if you have suffered a loss of income, and to do so without violating social distancing.

  • Reporting Claims: insurers must extend all deadlines for consumers to report new claims or to communicate about claims.  They also must give consumers the ability to report claims while maintaining safe social distancing. With these protections, you will still be able to get the benefits of your coverage if you need to make a claim.

  • For additional information, you can refer to the Department of Consumer and Business Services’ landing page for coronavirus response.

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Coverage Under The Oregon Health Plan

If you’ve been laid off and lost health coverage provided by your employer, you may qualify for coverage under the Oregon Health Plan (“OHP”).  Your eligibility for OHP is determined based on your current monthly income - so if you expect to have little or no household income as the result of a lay-off, you can probably apply for OHP.  Here’s what you need to know about the Oregon Health Plan:

  • Under OHP, you do not owe any monthly premiums, and in most cases you will not owe anything out-of-pocket for your care.  This includes coverage for COVID-19 testing if your provider approves it, and any treatment related to a novel Coronavirus infection.

  • You can apply for OHP coverage through the Oregon Health Authority’s website.  You may also request a paper application through the mail by calling OHP customer service at 1-800-699-9075.

  • You can also submit an application through the Oregon Health Insurance Marketplace , which will automatically submit a OHP application to the Oregon Health Authority if you qualify.

  • Unlike most health insurance, applications for OHP are open year round, and are not subject to an open enrollment period.  If you are eligible for OHP, you can apply at any time.

  • You can learn more about the Oregon Health Plan at the Oregon Health Authority’s website.

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Private Coverage Through the Insurance Marketplace

If you have been laid off and are at risk of losing health coverage provided through your employer, you are eligible for a special enrollment period for three months on the Oregon Health Insurance Marketplace.  Even if you have not been laid off, you may be eligible for special enrollment under other limited circumstances. Most people who apply for coverage on the marketplace are eligible for assistance paying for premiums through “Advance Premium Tax Credits,” which will reduce your out-of-pocket cost for health insurance premiums depending on your income.  Here’s what you need to know about Coverage on the Marketplace:

  • You can apply for coverage at the Oregon Health Insurance Marketplace, Oregon’s individual market exchange.

  • If you are eligible for a tax credit, your cost per month will probably be significantly lower than your coverage through “COBRA”.  

  • All plans on the marketplace have comprehensive coverage, and you can’t be turned away or charged more for a pre-existing condition.

  • If you were offered family insurance coverage through a spouse or other family member, and declined the offer, you may not be eligible for subsidies for your premiums.  If this is the case, it may be more economical to use your “COBRA” benefits [link] or see if you are eligible for the OHP.

  • Oregon’s Marketplace has a “Window Shopping” tool, which can help you select a plan by showing your likely out-of-pocket costs under different plans.  This could be a better way for you to assess the differences between different company’s options instead of trying to dig through the numbers on Healthcare.gov.

  • You can only apply for coverage on the marketplace outside of the annual open enrollment period (November 1 - December 15) if you qualify for a special enrollment period.  Don’t wait to apply! If you qualify for special enrollment but don’t apply, you won’t be able to get covered until January 2021. 

Here’s some quick tips on how to shop and apply for individual market coverage.  You can find additional information at www.oregonhealthcare.gov or on OSPIRG Foundation’s annual open enrollment guide from 2019.

 

  • Don’t just look at the premium. Out-of-pocket charges for health care services and prescription drugs can quickly break the bank if you aren’t careful, especially if you have health conditions that need regular medical attention. Plans with low premiums often have high out-of-pocket costs, so be sure to check co-pays, deductibles and co-insurance rates as well as premiums. Healthcare.gov includes an online tool that can provide a rough estimate of yearly out-of-pocket expenses for each plan as you shop.

  • To look into the details of costs and coverage for different services, check a plan’s Summary of Benefits and Coverage document, which is available via healthcare.gov.

  • Check out the plan’s network. Health insurance plans usually have a network of participating doctors and hospitals, and may not allow you to go outside that network, or may charge you more if you do. Some insurance companies may also have different networks for different health plans they offer. Some health insurance plans try to keep down costs by having very small networks that limit consumer choice. This is not necessarily a bad thing—it can save you money—but it’s important to make sure you know what you’re buying, especially if you have a relationship with a doctor that you want to keep.

  • For additional information on shopping for and enrolling in a plan on the Marketplace, check out www.oregonhealthcare.gov or OSPIRG Foundation’s annual open enrollment guide from 2019.
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“COBRA” Coverage Through a Former Employer

If you have lost health coverage through your employer, in most cases you have a right to continuation of group health benefits (“COBRA”), though you will have to pay the cost of premiums if you elect to keep your group coverage.  This Federal law applies to most private employers with more than 20 employees. In Oregon, state law gives you the right to continue your group coverage for most smaller employers for up to 9 months (“mini-cobra”).

The law requires your employer to provide information on your right to COBRA benefits, so if you would like to consider this option, you should review the materials you received upon leaving your job very carefully.  If you have not kept those materials, you should contact your employer or former employer for information about COBRA benefits.

  • In general, COBRA coverage will be more expensive for you each month than your coverage was prior to losing benefits.  While you have a right to retain your coverage for a period of 18-36 months (under the federal law), your employer is not required to contribute to COBRA premiums and you must bear the entire cost of insurance yourself.

  • You have 60 days from the date you would otherwise lose coverage to elect to enroll in COBRA, if you are covered under the Federal law.  Even if you do not choose to keep your coverage within this period, you must be allowed to re-enroll for up to six months after losing coverage, but you WILL NOT BE COVERED for medical claims from before the date you elect to reinstate your coverage.

  • If you are covered by state COBRA (“mini-COBRA”), because you were employed by a small business not covered by the Federal law, you have 10 days to give notice to your insurance company that you wish to continue coverage.

  • You may wish to pay for COBRA coverage if you have ongoing medical expenses and want to maintain continuity of care with your current providers, as plans on the individual market may not include all providers in their network.

  • Even if you are eligible for COBRA, OSPIRG Foundation recommends creating an account on the Oregon Health Insurance Marketplace and checking your eligibility for premium payment assistance or the Oregon Health Plan.  You may be able to find comparable or better insurance at a lower premium cost to you.

For more information about Federal COBRA coverage, you may visit the Department of Employment website.  For more information about Oregon’s state COBRA coverage, you may visit the Department of Consumer and Business Services website.

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Health Care Protections Under the Federal COVID-19 Relief Bill

Graphic Courtesy of Oregon Health Authority

The Families First Coronavirus Response Act was signed into law by President Trump on Wednesday, March 18th, after receiving bipartisan support in both the House and Senate chambers.  In addition to provisions on increased paid sick leave, expanded funding for unemployment insurance, and nutrition assistance, the bill requires comprehensive coverage of diagnostic testing for the novel coronavirus.

  • Under the new law, all comprehensive health insurance coverage, including employer-sponsored insurance, Medicare, Medicare Advantage, and individual plans are required to cover FDA-approved testing needed to detect or diagnose coronavirus, and the administration of that testing without cost-sharing (such as co-pays) or barriers (such as prior authorization).

  • The Coronavirus Aid, Relief, and Economic Security Act (“CARES”) prohibits surprise billing for diagnostic testing for the novel coronavirus.  Insurers must pay labs either the full rate they have negotiated with labs prior to the COVID-19 outbreak, or a publicly posted “cash” price listed by the lab.  Note that this only covers testing, and does not provide “surprise billing” protections for any treatment that is required by a COVID-19 diagnosis.

  • Plans are also required to cover any services or items provided during a medical visit that resulted in coronavirus screening or testing.

  • States have the option to provide coronavirus screening and testing to uninsured individuals through their Medicaid program.  States that elect to do so will be reimbursed for those costs by the Federal government, but there is no guarantee of coverage for any treatment resulting from a diagnosis of COVID-19.

As of April 7th, the state of Oregon has not guaranteed coverage of COVID-19 testing for uninsured individuals.  If you seek testing, and are not covered by insurance, you may be held responsible personally for the cost of the test. Return to top.

Public Charge, Options for the Uninsured, Surprise Billing, and More

  • Options for the Uninsured: Hospitals in the United States can not refuse emergency care to patients, regardless of whether they have insurance or are able to pay. If you need emergency care for COVID-19, emergency rooms cannot turn you away.  In addition, the federal government has announced it will use funds from the CARES Act to reimburse hospitals for all coronavirus related care. However, there is no guarantee any particular hospital is participating in this program, and hospitals may still attempt to collect costs from you after treatment if you are unable to pay.

  • Public Charge: The Trump administration has pledged not to enforce the terms of the controversial “public charge” rule, which can affect eligibility for a green card, during the COVID-19 pandemic.  Seeking diagnosis or treatment for the novel Coronavirus will not affect immigration status.

  • Surprise Billing: If you seek emergency services and you have insurance coverage, you may not be charged higher out-of-network rates for treatment if you have individual coverage or (in many cases) employer coverage.  If you have coverage through a large employer, however, you may not be protected by Oregon’s “surprise billing” ban. Even in an emergency, you should try to make sure you are going to in-network facilities whenever possible.  (Note: the CARES Act, passed by the Senate on March 25, 2020 prohibits surprise bills for diagnostic testing for the novel coronavirus, but does not provide protections for treatment of COVID-19).

We know that this is an unprecedented and high anxiety time.  OSPIRG is working hard to make sure consumers are informed about their rights and health resources in the midst of the COVID-19 pandemic.   This post will be updated as developments continue, and in the meantime, you may visit our COVID-19 landing page for comprehensive information.

You can get consumer tips on avoiding coronavirus scams, getting travel refunds, shopping safely, and more at our consumer tips page. We’re also working to make sure everyone who needs a test, gets a test (sign our petition to Admiral Brett Giroir, the federal head of Coronavirus testing).

For other resources and information on the novel coronavirus in Oregon, you can visit the Oregon Health Authority, or the Federal Center for Disease Control. To return to the index, click here.

Numi Lee Griffith
High Value Health Care, Advocate

Author: Numi Lee Griffith

High Value Health Care, Advocate

Started on staff: 2018
B.A., University of Puget Sound; J.D., University of Colorado, Boulder

Numi runs OSPIRG’s health care campaigns, working to control the skyrocketing cost of prescription drugs and ensure Oregonians receive the high-quality health care for their dollar. Before joining staff, Numi worked as an attorney in private practice, focusing on consumer rights, real estate and intellectual property law. When she isn’t working, you can usually find Numi at one of Portland’s many rock climbing gyms or coffee shops.