Eligibility Woes: The Impact of COVID-19 on Insurance Coverage

With an increasing amount of coverage changes happening at the moment, it’s now more important than ever to verify medical benefits and determine accurate patient coverage. Urban Institute estimates that up to 43 million individuals will be impacted by furloughs as a result of the COVID-19 pandemic. This means millions will be losing their employer-sponsored healthcare coverage and will be scrambling to find solutions. Many of these individuals will qualify for government assistance, while others may opt to purchase private insurance or remain uninsured.

The Center for Medicaid and Medicare Services reported that nearly 900,000 individuals signed up for HealthCare.gov plans after losing healthcare coverage from mid-December to May 2020, which represents a 26 percent increase in applications than same period last year. Urban Institute expects that approximately 47 percent of those losing employer-sponsored health insurance will resort to Medicaid.

The same report anticipates that approximately 25 percent of those losing coverage will turn to the marketplace. One avenue expected to see a large increase in enrollees are short-term health plans. 600,000 people enrolled in STHPs in 2019, bringing the total number of enrollees to 3 million. CMS estimates the number of annual STHP enrollees to increase to 1.6 million by 2021. One caveat with STHPs is that they are not equivalent to traditional health plans, specifically employer-sponsored insurance plans, with higher out-of-pocket costs typically directed to the patient.

With a staggering amount of consumers dealing with the health and economic crisis, keeping track of new insurance information on top of numerous other hurdles associated with unemployment can be difficult. New insurance cards could get lost in the mail, or forgotten at home. Some patients may not know when or if their coverage has been terminated and are hopeful their old insurance information is still valid. Patients with short-term health plans with high out-of-pocket costs may not be prepared for what their true financial responsibility might be.

In these times of anxious uncertainty, a practice must find ways to ensure their patients are given all the information relative to their care. This includes the eligibility and coverage benefits that pertain to the visit, along with any estimated financial obligations. Some patients may not know if they even have coverage or not. Practices must be diligent in discovery not only if the patient has coverage, but to determine exactly what options are available.

How do practices do this? Payer websites can help provide this information, but you’ll need to have the time to search, not to mention remembering multiple logins. Estimations are a bit more difficult, having to be aware of various payer reimbursement rates. What if even the patient’s insurance carrier is unknown? How can a practice hunt that down?

Partnering with an RCM solutions vendor that offers streamlined, robust solutions including eligibility and benefits verification, patient responsibility estimation and self-pay insurance discovery enables practices to easily find the information they need so they can focus on delivering exception care.