On March 5, Nevada Governor Steve Sisolak adopted an emergency regulation intended to guarantee that Nevadans wouldn't have to pay for COVID-19 testing.
Since then, the federal government has followed suit, passing the Families First Coronavirus Response and CARES Acts, which both included legislative changes designed to ensure most Americans’ insurance plans would cover testing and treatment for the disease.
But insurance is tricky… full of exceptions and terms that can allow some insurers to skirt the law. So, what is and isn't covered by your insurance when it comes to COVID-19?
According to the Nevada Division of Insurance, the treatment of COVID-19 must be covered according to your health insurance plan.
Copays and deductibles will apply to treatment. If you have specific questions about your coverage call your insurance company.
Under the governor's order, testing for coronavirus must be covered.
Barbara Richardson is the insurance commissioner for the Nevada Dept. of Business and Industry.
The Division of Insurance oversees individual and small business insurance plans and reviews plans for larger companies. So, the rules laid out by the division apply to them — not public plans like Medicaid and Medicare and plans offered under the Affordable Care Act exchanges.
Richardson said while paying for testing is required, her office has requested that insurance companies pay for treatment and most have agreed to expanded services.
“I think what we’ve actually seen is an embracing of the terms from the insurance companies to go above and beyond what we asked them to do under the emergency regulation, and they’re following more of the guidance that we provided them asking them to expand their services,” she said.
In particular, Richardson said, many companies are expanding allowances and services for mental health.
If your health insurer does not cover medical services related to COVID-19 testing, file a consumer complaint through the Division of Insurance consumer complaint portal at http://doi.nv.gov/Consumers/File-A-Complaint/ or by calling consumer services at (775)687-0700.
For those who are uninsured or have lost their employer-provided care because of layoffs, Nevada Health Link has opened a special enrollment period for health insurance offered under the Silver State Health Insurance Exchange, which provides plans under the Affordable Care Act also known as Obamacare.
“In light of our declaration of disaster, we opened up a special enrollment period. It’s called an exceptional circumstance special enrollment period. Any Nevadan who did not get covered, and is currently uninsured has an opportunity right now from March 17 through April 15 to get enrolled in a special enrollment period,” said Heather Korbulic, executive director of the Silver State Health Insurance Exchange.
Korbulic said a majority of people getting insurance through the exchange are getting help paying for it with subsidies. She advised that people who have lost their jobs, and employer-provided coverage along with it, should not only enroll through the exchange but also apply for subsidies.
For more information visit nevadahealthlink.com/coronavirus/.
Korbulic added the plans offered on the exchange cover essential services outlined in the ACA, including anything deemed medically necessary, such as testing and treatment of coronavirus.
Another option for people who've lost their job is Medicaid.
There is no open enrollment period for Nevada Medicaid. People who qualify for the benefit can sign up any time. To see if you qualify, go to accessnevada.dwss.nv.gov.
“Part of our response to the COVID pandemic has been requesting some additional flexibilities that are allowed from the federal government only during the time of natural disasters,” said Suzanne Bierman, administrator at the Division of Health Care Financing and Policy, which oversees Nevada's Medicaid program.
She said enrollment has been streamlined and some reimbursement rules have changed because of the emergency.
Like ACA plans, Medicaid must cover tests and care that is deemed medically necessary.
- Nevada Medicaid covers a broad range of benefits. Below are benefits that are covered by Nevada Medicaid and Nevada Check Up due to COVID-19. All benefits must be deemed medically necessary in order to be covered by Nevada Medicaid and/or Nevada Check Up.
- Physician Services
- Therapies
- Behavioral Health Issues
- Testing, Diagnostics, Laboratory Services
- Vaccinations
- Hospital Care (Inpatient/Outpatient)
- Pharmacy
- Durable Medical Equipment, Prosthetics, Orthotics and Disposable Medical Supplies (DMEPOS)
- Nursing Facilities
- Rehabilitation
- Skilled Nursing
- Long-Term Care
- Home Health
- Hospice
- Telehealth
- Emergency Transportation
- Non-Emergency Transportation
- Child Health Services
Suzanne Bierman, administrator, Division of Health Care Financing and Policy, Nevada Dept. of Health and Human Services; Heather Korbulic, executive director, Silver State Health Insurance Exchange; Barbara Richardson, Insurance Commissioner, Nevada Dept. of Business and Industry
