×

COVID-19 FAQ- NYS Health Insurance

Health Team April 08, 2020

COVID-19 PANDEMIC

FAQS NEW YORK STATE HEALTH INSURANCE  

Last Updated: April 19, 2022

GENERAL HEALTH INSURANCE QUESTIONS

Q. I heard health insurance plans now have to provide free or reimbursable at-home COVID-19 antigen tests. Is that true? How does this work?

A. Yes. Find your insurance type below and if you have further questions, we would encourage you to reach out for legal assistance. Also, if your household has not received your first or second batch of 4 free COVID-19 tests from the federal government, you may visit here.

  • Private or commercial insurance plans (typically through employer): Beginning January 15, 2022, individuals with private health insurance coverage or covered by a group health plan who purchase an over-the-counter (OTC) COVID-19 diagnostic test will be able to have those test costs covered by their plan or insurance.
    • This requirement does not apply to any OTC tests purchased prior to 1/15/22.
    • The OTC test must be authorized, cleared, or approved by the U.S. Food and Drug Administration
    • A maximum of 8 tests will be covered per enrolled individual, per month (a family of 4, all on the same plan, would be able to get up to 32 of these tests covered by their health plan per mfonth).
    • There is no coverage for at-home tests purchased to fulfill an employment, school or travel requirement.
    • To find out how your plan is providing free or reimbursable tests to its members, reach out to your plan
    • There is no limit on the number of tests, including at-home tests, that are covered if ordered or administered by a health care provider following an individualized clinical assessment, including for those who may need them due to underlying medical conditions.
  • Medicare, Medicare Advantage Plans: Beginning April 4, 2022, Medicare will cover up to 8 OTC at-home COVID-19 tests each calendar month at no cost. These tests will be covered by Part B for those enrolled in Part B. Please see this link for more info.
  • Medicaid, Medicaid Managed Care, Health and Recovery Plans, Child Health Plus, Essential Plan: members are eligible for 2 tests per week with an attending provider order. See NYS Medicaid Pharmacy Policy and Billing Guidance for At Home COVID-19 Testing Coverage.

Q. I don’t have health insurance, is it too late to apply on the New York State of Health (NYSOH) Marketplace?

A. New York State runs its own health exchange and, in light of the COVID-19 public health emergency, extended the Open Enrollment Period (OEP)  through the duration of the public health emergency. During this OEP, uninsured individuals can enroll in insurance coverage though the NYSOH Marketplace or directly through insurers (Qualified Health Plans.)

NYS funds the In-Person Assistor/Navigator program to provide assistance for individuals interested in shopping for and enrolling in health insurance through the Marketplace. Search here for assistance in your geographical area.

Q. How do I know if my health insurance plan offers telemedicine?

A. Telehealth or telemedicine is, broadly speaking, the provision of remote health care services through the use of electronic information and communication technologies. As the healthcare industry adapts during the crisis, we are seeing a rapid expansion in the need for telehealth services to allow people to visit with their provider from home, and without putting themselves or others at risk. Access to telehealth has also been expanded for Medicare beneficiaries, enabling individuals to receive certain services through telehealth including routine office visits, mental health counselling and preventative health screenings.

If you need to see a healthcare provider, for any reason, ask about available telehealth options and whether it will be covered for your specific medical need. For employer-sponsored, marketplace plans, and other types of health insurance, you can also call your health plan, or go online to search your benefits on your policy’s member portal for the most up to date information.

Q. What if I (or my spouse) was laid off due to the pandemic? Do I still have health insurance?

A. Depending on the size of your employer and the type of health plan, you may have the option to pay for continued coverage under the group healthcare plan for up to 36 months. This is known as  COBRA coverage. If eligible, you will receive notification from the plan administrator of your option to purchase continued coverage. This can be a hassle-free way to keep the same coverage and access to all the same providers and covered medications. In this time of crisis, it will be tempting for many people, especially those who have always had coverage via their employer, to sign up straight away. However, COBRA is usually much more expensive because employers have typically been paying part of the insurance costs. Once you elect for coverage under COBRA, the full amount of that cost can be charged to you as an individual. At the very least, make sure you know the amount of the increased cost and determine whether that is going to be affordable going forward.

Generally, you will have 60 days to elect COBRA continuation coverage after losing your employer coverage. You will also have a separate Special Enrolment Period (SEP) to buy health insurance coverage though the NYSOH Marketplace for 60 days.

We would urge anyone in this position of job loss during the crisis to pause and take a step back before making a hasty decision regarding health insurance. It is important to consider all options that may be more affordable given any change, either short term or long term, in your household finances. Depending on your age, household income and resources, and foreseeable medical needs, there may be other options that provide comprehensive coverage at a much lower cost than COBRA coverage, including Medicaid, the Essential Plan, subsidized Qualified Health Plans or Child Health Plus.

While the above information is generally true, on March 11, 2021, President Biden signed the American Rescue Plan Act of 2021 (“ARP”). The ARP provides that qualified individuals do not have to make COBRA premium payments for up to 6 months for effective dates April 1, 2021 – September 30, 2021. During this time, the individual’s employer would make payments on their behalf and then claim those payments as a write-off on next year’s taxes. To find out if you are a “qualified” individual for purposes of this program, click here.

If possible, speak to an In-Person Assistor/Navigator about the options that are available to you through the Marketplace. You can search  here for assistance in your geographical area.

For those who are Medicare eligible, coordinating COBRA coverage will bring even more challenges. There is no SEP for Medicare when COBRA ends. If you do not enroll in Medicare Part B immediately, and you do not have other active employer-sponsored coverage when COBRA ends, you may face costly and ongoing Part B premium penalties for late enrollment.

People who wish to enroll in Medicare for the first time under their Initial Enrollment Period may do so online at www.ssa.gov (i.e., turning 65). Medicare applicants under an SEP may mail or fax their forms to the local Social Security. Click here for more information. Call the Health Insurance Information Counseling Assistance Program (HIICAP) helpline at 1-800-701-0501 to speak to a counselor, or 1-800-Medicare for further assistance and guidance

Q. I heard coronavirus testing is free for all New Yorkers, is that true? 

A. Yes, coronavirus testing is free for all eligible New Yorkers as ordered by a health care provider or by calling the NYS COVID-19 hotline at 1-888-364-3065. Your local health department is your community contact for COVID-19 concerns. Be aware that you may not be eligible for testing due to limited supplies and strict eligibility requirements. It is also important to note that if you go to a test site run by New York State, there is never any charge for your test. However, if you go to a test site operated by local governments, private companies including pharmacies and medical practices or not-for-profit organizations, you are advised to check with the testing site and your insurer in advance of being tested to confirm you will not be responsible for any fees associated with your test.

Coverage for the uninsured/underinsured will depend on a variety of factors. If you are unsure of your eligibility for coverage, we would encourage you to reach out for legal assistance.

Q. I am now eligible for the COVID-19 vaccine or booster. How much will it cost me?

A. COVID-19 vaccines are free and available to all eligible individuals, regardless of immigration or health insurance status. You should not have to pay anything out of pocket to get the vaccine, although you will be asked for insurance information. If you don’t have insurance, you should still be given the vaccine at no charge. Vaccinations and administration, including any visits necessary to obtain the vaccination, must be covered without cost-sharing (i.e., vaccination and administration cannot be subject to annual deductibles, co-insurance, copayments or any other out-of-pocket cost). However, although additional services cannot be required in order for someone to receive the vaccine, they can be provided at the same time and billed as appropriate. If you are worried about a potential surprise bill, be sure to talk to your provider or pharmacy about any hidden fees. More info on the vaccine can be found here.

To all Medicare and Medicare Advantage Plan members: Vaccination and administration will be billed to Original Medicare (Part B). Be sure to bring your Medicare card with you when getting vaccinated so that your health care provider or pharmacy can bill Medicare. Those on a Medicare Advantage Plan may not be used to seeing a Medicare Summary Notice (MSN). The MSN is a notice that all people with Original Medicare receive in the mail every 3 months that shows all Part A and Part B-covered services or supplies billed to Medicare during 3-month period, what Medicare paid, and the maximum amount you may owe the provider. Since members in a Medicare Advantage Plan will also have their vaccination and administration services billed to Original Medicare (Part B), they may also receive an MSN, indicating the vaccine was billed to Part B and no amount should be owed.

Beware of vaccine fraud! To help root out vaccination fraud or scams across the State, New York established a hotline that New Yorkers can call to report suspected fraud. It is a red flag if anyone is promising you the vaccine in exchange for payment, or if anyone is asking for your Medicare Number. To make a report, call 1-833-VAX-SCAM (1-833-829-7226) or email STOPVAXFRAUD@health.ny.gov.

If you have any further questions, or need assistance on a health insurance matter, please contact our health team by email, health@empirejustice.org.

Please note: Do not send us any nonpublic information about any legal matter for which you seek legal representation until we request that you do so. Empire Justice attorneys will inform you if and when your matter is considered for legal representation. Until that time, any information you provide WILL NOT be considered confidential, and NO attorney-client relationship is formed by communications received through this website. Any information available on the website is for general legal education purposes only, and is not legal advice.