Faqs about insurance claims amid coronavirus pandemic

MY BUSINESS WAS TEMPORARILY SHUT DOWN BY THE PANDEMIC. WILL INSURANCE COVER MY LOSSES? It depends on the terms of your policy. Talk to your insurance company or broker, but be prepared for

bad news: Even if your insurance includes “business interruption” coverage, it might not cover losses from the outbreak. Business interruption coverage is typically tied to physical damage

from a cause you are insured for, such as a fire or hurricane. Absent such damage, it can be difficult to press a claim, says Shannon O’Malley, a partner in the Dallas office of the national

law firm Zelle LLP, who wrote in-depth analysis of the issue early in the pandemic. In addition, many business policies explicitly exclude claims arising from a virus or communicable

disease, or don’t address those causes, which can effectively mean the same thing. A flurry of lawsuits filed by businesses ranging from restaurants and hair salons to Major League Baseball

teams have challenged insurance companies’ denial of COVID-related claims, but state and federal courts are largely finding for the insurers, according to tracking by the University of

Pennsylvania’s Carey Law School. Even if a policy includes “civil authority” provisions related to a government order to close, these typically require that the order arise from physical

damage caused by a covered event, O’Malley says. Claims on this basis are complex and contingent on individual circumstances; consider consulting an attorney well versed in insurance law to

discuss your situation. WILL MY HEALTH INSURER MAKE ME PAY ANYTHING IF I NEED CORONAVIRUS TREATMENT? Probably. Most large insurers waived cost-sharing for COVID-19 treatment for most of 2020

and into 2021, but they are now generally applying copays, coinsurance and deductibles for such services. Regardless of your insurer, you should not have to pay anything out of pocket for

federally approved COVID-19 vaccines. Major insurers continue to cover COVID-19 diagnostic tests in most circumstances and, under federal guidelines, must pay for up to eight at-home rapid

tests a month for members of their plans. (You may need to pay upfront for over-the-counter rapid tests and file a claim with your insurer for reimbursement; check with your plan provider.)

  More information is available from insurers’ websites. If your provider is not listed, call your health plan’s customer service number to find out about its coronavirus response. * AETNA: 

No cost-sharing for diagnostic testing to determine whether treatment is needed, or for antibody tests ordered by a physician or medical professional. The waiver does not apply to tests for

the purpose of returning to work or school, except as required by law. Cost-sharing is in effect for treatment for COVID-19. * ANTHEM: No out-of-pocket costs for doctor-ordered COVID-19

testing and test-related visits. Copays, coinsurance and deductibles apply for COVID-19 medical care, according to the terms of your health plan. * BLUE CROSS/BLUE SHIELD: Blue Cross/Blue

Shield is an association of member companies that operate independently, and COVID-19 cost-sharing policies may differ from state to state. Use the map at the Blue Cross/Blue Shield

coronavirus web page to check on procedures in your state. * CIGNA: No out-of-pocket costs for COVID-19 diagnostic tests, or for diagnostic office visits with an in-network provider, through

the end of the federally declared public health emergency, which currently runs until July 15, 2022. There is cost-sharing for COVID-19 treatment. * HEALTH CARE SERVICES CORPORATION (HCSC):

 No cost-sharing for FDA-approved COVID-19 diagnostic tests or for testing-related visits with in-network providers until the end of the public health emergency. Out-of-pockets costs apply

for COVID-19 treatment. * HUMANA: COVID-19 diagnostic tests are 100 percent covered for Medicare Advantage plan holders in all circumstances and for members insured through employer plans if

the test is ordered by a health care professional. Out-of-pockets costs for COVID-19 treatment are waived for the 2022 plan year for Medicare Advantage members, but standard copays,

coinsurance and deductibles apply for people with employer plans. * KAISER PERMANENTE: No-cost testing is available to members. COVID-19 treatment is subject to your policy's

cost-sharing provisions. * UNITED HEALTHCARE: No out-of-pocket costs for FDA-approved diagnostic tests ordered by a health care professional, or for testing-related visits, during the

federal public health emergency. Standard cost-sharing applies for COVID-19 treatment. IS MEDICARE COVERING COVID-19 VACCINES, TESTING AND TREATMENT? Medicare will pay all costs for any

federally authorized COVID-19 vaccine, for testing ordered by a doctor or other health care provider, and for over-the-counter at-home tests (up to eight per month). There will be no

out-of-pocket costs, whether you have Original Medicare or a Medicare Advantage plan. People with original Medicare who are hospitalized for COVID-19 treatment will still have deductibles

and copays. If you have a supplemental Medigap plan, it may cover these costs. If you have Medicare Advantage, out-of-pocket costs for hospital and outpatient treatment vary by plan. Contact

your Advantage plan provider. You'll find more information in our AARP Answers on Medicare and the coronavirus. WHAT ABOUT AFFORDABLE CARE ACT (ACA) HEALTH PLANS? Heath insurance

purchased through the ACA marketplace is required to cover emergency services and hospitalization, and that would apply to such treatment for COVID-19. You may incur out-of-pocket costs,

depending on your plan. Ask your plan provider about its coverage. I DON'T HAVE HEALTH INSURANCE. CAN I GET COVERED? You may be able to get Medicaid, the federal-state health care

program for low-income people, or an ACA plan. Medicaid enrollment is open all year. More than 13 million people have signed up since the start of the pandemic, according to tracking by the

Kaiser Family Foundation. Eligibility is based primarily on income and differs by state — contact your state's Medicaid program for information. ACA plans in most states are sold

through the federal marketplace. Open enrollment for 2022 plans ended Jan. 15. For 2023 coverage, federal open enrollment runs from Nov. 1 to Dec. 15. Some states operate their own ACA

exchanges and maintain different enrollment periods; check with your state's exchange for information.   Outside of your state's open enrollment window, you can sign up for an ACA

plan if you qualify for a special enrollment period due to a life-changing event, such as a loss of previous health coverage. Some health insurers sell short-term policies with low premiums,

but these offer limited benefits and, unlike with Medicaid and ACA plans, you can be turned down for a preexisting condition. Closely read and carefully consider a short-term plan's

provisions before signing up. _Editor’s note: This story has been updated to reflect new COVID-19 information_.