Coverage and COVID-19-related costs
Under an agreement between the state and health insurance companies, there are no co-payments, co-insurance, or deductibles related to COVID-19 for testing at an in-network provider, in-network urgent care center, or emergency room, or COVID-19 immunization.
Immunization/vaccine: The CARES Act generally requires health insurance companies to provide coverage, without cost sharing (co-insurance or co-payments), for in-network qualifying coronavirus preventive services, including a COVID-19 vaccine and its administration, and during the COVID-19 public health emergency, from out-of-network providers, as well.
Lab and other services: Individual and small group market insurers are generally required to include laboratory services as a category of essential health benefits. Coverage for a specific diagnostic or laboratory service can vary by plan, so check with your health insurance company about its coverage for lab tests and related services for diagnosis and treatment of COVID-19. Standard cost sharing may apply. This is also true for your health plan's coverage for physician and hospital services related to the diagnosis and treatment of COVID-19.
Telehealth: Telehealth services or home health visits may already be covered by many health insurance companies. You should check with your health insurance company to determine whether these services are covered and what you will pay.
Enrolling in coverage: If you are not currently enrolled in coverage, you can see if you qualify for a special enrollment period. As a reminder, federal law and regulations provide protections against pre-existing condition exclusions in health insurance coverage. If you are eligible, health plans must permit you to enroll, regardless of health status, age, gender, or other factors that might predict the use of health services. Marketplace plans cannot terminate coverage due to a change in health status, including diagnosis or treatment of COVID-19.
Marketplace enrollment due to national emergency, major disaster
Oregonians affected by COVID-19 can use the federal emergency declaration by the Federal Emergency Management Agency (FEMA) to take advantage of an exceptional circumstances special enrollment period (SEP). FEMA declared the COVID-19 pandemic an emergency in Oregon on March 8, 2020.
Oregonians will have up to 60 days from the end of the FEMA-designated incident period to select a new health insurance plan through HealthCare.gov or make changes to their existing health insurance plan. People who experienced a life change are eligible for a standard special enrollment period that allows them to sign up for a plan 60 days before or 60 days after their life change to enroll in a plan. Examples of a life change include loss of coverage due to loss of employment, marriage, addition of a new family member, gaining lawful immigration status, and moving homes.
Oregonians who were eligible for a standard special enrollment period, but missed this window due to the COVID-19 pandemic, can use the FEMA SEP to enroll in a plan. Applications are being accepted at HealthCare.gov if the life change is a loss in coverage and at 800-318-2596 (toll-free) for all other life changes.
The FEMA SEP due to COVID-19 is available for people who qualified for a special enrollment period from Jan. 1, 2020, through up to 60 days after the national public health emergency has ended. The current national declaration is set to end in late October.
For more information, visit HealthCare.gov/SEP-List.