This guide is on a federal program that supports essential medical services for COVID-19. Informally, it is known as the “uninsured COVID program.” And just as it sounds, it is in place to assist those without health insurance. Here, we walk you through it.
It gives people access to key health services. These include testing, treatment and vaccinations.
More, many health providers participate in it. And the providers range from pharmacies and clinics to hospitals and ambulance services. A provider must enroll in order to qualify for reimbursement.
Here is how it works: a provider will determine if a patient qualifies for coverage. Then, they will submit a claim directly for services. In turn, the program reimburses them directly. That is it.
Everyone has a stake in the pandemic. And access to key medical services is key. And this effort provides that. More, it impacts everyone.
Key Questions & Answers
How do I find health service providers that participate in the program?
Not all providers participate. The best way to find out if they participate is to ask them: “Do you participate in the Covid uninsured program?”
Who is eligible for coverage and what does “uninsured” mean?
“Uninsured” means that the patient has no coverage from another policy or program. And only then do they qualify.
Do “undocumented” individuals qualify?
Yes. Health care providers are not required to confirm immigration status.
Are Indian Health Service (IHS), Tribal and Urban Indian Program (I/T/Us) beneficiaries considered “uninsured individuals” ?
No. They do not qualify because they are in the I/T/U, a federal health care program.
How does it work? Who receives the funding?
Health care entities qualify for several services provided to those without insurance. They can file a claim for administering a test or vaccination. If a patient is positive for the virus, they can get reimbursement for treatment.
Can I go to a pharmacy?
Yes. Pharmacies that administer testing or vaccination services can participate. Contact them to confirm they participate.
What about telehealth and remote services?
Yes. You can talk with a health professional remotely. This is especially key with COVID-19.
If I go to a hospital with symptoms, but my COVID-19 test is negative, is this covered?
Yes. Diagnostic testing and testing services are paid by the program. The result of the test has no impact on the coverage.
If a COVID-19 test came back as negative, do I have to pay for the test?
No. A test is paid regardless of the result. It does not require a positive test result to qualify.
What about ambulance or emergency medical providers?
Yes, but there are some things to know. First, like all providers, they have to be willing to participate in the Uninsured Program and being willing to submit a claim on your behalf.
Many ambulance services do participate in the program. And they are submitting claims which are being paid. But to qualify, the service has to be for:
Someone who pregnant, but are showing symptoms of COVID-19.
Or an potentially life-threatening emergency for someone showing symptoms of COVID-19.
Thus, for pregnancy, COVID-19 does not have to be the primary reason for the service. But for all others, it does.
What services are not covered by the program?
Services not covered by traditional Medicare will also not be covered under this program. In addition, the following services are excluded:
- Any treatment without a COVID-19 primary diagnosis, except for pregnancy when the COVID-19 code may be listed as secondary.
- Hospice services.
- Outpatient prescription drugs.
I paid the provider. They participate in the Uninsured Program. Are they required to reimburse me?
Yes, if they apply for and receive reimbursement from the program. Find out in advance if they are enrolled in the program. If so, they cannot bill you for the service.
Who oversees the program?
The program is being administered by UnitedHealth Group. It is through a contract with the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA).
Illustration by Natasha Remarchuk