35
treatment is likely to be covered, the details on
Medicare deductibles and potential co-pays will
again depend on people’s Medicare plans or state-
specific Medicaid rules.
For those, like Askini, who are uninsured, the op-
tions are limited. Some hospitals offer charity-care
programs, and some states are making moves to
help residents access coverage. A growing number
of states have created “special enrollment periods”
to allow more people to sign up for Affordable Care
Act marketplace insurance plans midyear.
The U.S. Congress has been debating various
measures to deal with treatment costs, but none
of them appeared to be central to the $2 trillion
package lawmakers were negotiating on March 25
for imminent passage. Summaries of the bill
showed $100 billion in funds allotted for hospi-
tals, moves to boost access to telehealth services,
coverage of coronavirus- related vaccines with no
cost sharing, and an attempt to cut down on sur-
prise billing. But these would not address treat-
ment costs, and gaps remain.
Patient advocates suggest families keep an eye
out for cost savings where possible. For example,
they advise people who suspect they have COVID-
19 to call their doctor before going to the emergency
room. In many cases, doctors will advise that even
patients exhibiting symptoms of COVID-19, like
fever and cough, stay home to recover. In cases that
require hospitalization, patients should be pre-
pared to be charged a “facilities fee” upon walking
through the door. Askini’s first trip to the hospital in
Boston on Feb. 29, for example, included a $1,804
charge for her ER visit and an additional $3,841.07
for “hospital services.”
Patient advocates also advise watching out for
unexpected charges for imaging or lab tests, which
can be “out of network” even if the doctor is not.
Patients should attempt to get all information in
writing so that they can appeal bills if necessary,
says Caitlin Donovan of the National Patient Advo-
cate Foundation. And appealing is worth it. Provid-
ers and insurers often reverse or lower bills when
patients negotiate or go public.
These problems aren’t new. Before the pan-
demic, Americans faced high health care costs
compared with the rest of the world, and millions
already delayed medical care as a result. But with
COVID-19 sweeping the country, this old prob-
lem may exacerbate the new one: by attempting to
sidestep health care costs, many Americans may
avoid being tested or treated for the virus, making
the outbreak worse in the end.
“If you’re sick, you need fewer barriers,” Dono-
van says. “But also, it doesn’t help society to have
people still crawling around going to their job and
getting other people sick.” —With reporting by
AlAnA AbrAmson/WAshington □ANALYSIS
JENA STARKES IS REALISTIC a bout t he c hallenges t hat
the C OV ID-19 p andemic p resents t o h er f amily. T he
4 5-year-old l ives w ith h er 8 1-year-old m other i n B rooklyn,
and i f e ither o f t hem c ontracts t he v iru s, t hey ’r e i n t rouble.
“If I g et i t a nd I g ive i t t o h er, i t i s u nlike ly t hat s he w ould
surv ive,” S tarkes s ay s. B ut i f S tarkes g ets i t a nd n eeds t o
be h ospitalized, s he’d h av e a p roblem t oo. “ What i f I h ad
to b e v entilated?” s he s ay s. “ What i f I h ad t o p ay $ 300 f or
a t est? I l iterally c ould n ot.”
Starkes o wns h er o wn web-design b usiness, s o s he
neither r eceives e mploy er-based i nsurance n or q ualifies
for M edicaid. B ut s he c an’t a fford t o b uy a n i ndividual
plan o n t he m arketplace. S o, l ike t ens o f m illions o f o ther
Americans, s he’s f acing d own a g lobal p andemic w ithout
heath i nsurance.
On March 18, Congress passed the Families First
Coronavirus Response Act, which addresses a small slice
of this problem: the cost of finding out if you’ve got COVID-
19 in the first place. The law requires that all existing
insurers—Medicare, Medicaid, other government plans
and most private insurance—cover all COVID-19 testing
and testing- related services. That means no co-pays,
no deductibles, no co-insurance charges: free. That’s
supposed to be true even if you don’t have insurance, like
Starkes. The law provided $1 billion to reimburse medical
providers for uninsured patients’ testing, and it allows
states to choose to pay for uninsured residents’ COVID-19
testing through their Medicaid programs.
But p atient a dvocates s ay i t’s n ot t hat e asy. T here
are p lenty o f o ther ways t he l aw f ails t o p rotect p eople,
ev en i f y ou h av e i nsurance. T he l aw s ay s t hat i nsurers
must c ov er p atient v isits t o d octors ’ o ffices, u rgent-care
centers , t elehealth p latform s o r e mergency r ooms,
so l ong a s t he s erv ices “ relate t o t he f urn ishing o r
administration” o f a C OV ID-19 t est o r “ to t he ev aluation
of s uch i ndividual f or p urp oses o f d eterm ining t he n eed”
of a t est. T hat m eans t hat i f y our v isit d oes n ot r esult i n a
COV ID-19 t est, y ou m ay e nd u p w ith a b ill. I t a lso m eans
that i f y ou g et t ested s omew here t hat i s n ot i n y our
insurance p lan’s n etwork , y ou m ay e nd u p w ith a b ill. A nd
if y ou r eceive a ny t reatment t hat i s n ot d irectly r elated t o
COV ID-19 t esting, you m ay, once a gain, e nd u p p ay ing.
“When y our h ealth p lan h as t o c ov er [ testing], t hat
just m eans t he h ealth p lan h as t o c ov er w hat i t w ould s ay
is a r easonable c harge,” e xplains K aren Pollitz, a s enior
fellow a t t he n onpart isan K aiser Fa mily Foundation.
“The d ifference b etwe en w hat y our h ealth p lan t hinks i s
reasonable a nd w hat t he p rov ider b ills y ou, t hat’s o n y ou.”
The l aw a lso c ov ers o nly t esting s tart ing t he d ay i t
wa s e nacted, March 1 8. S o i f y ou g ot t ested b efore t hen,
those s erv ices a re n ot r equired t o b e c ov ered.
That m ay s eem u nfair, but S tarkes i s u nsurp rised.
“That s ucks. B ut t hat’s A merica,” s he s ay s.BY ABIGAIL ABRAMS
THE HIDDEN COST
OF FREE T ESTING
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