How Long COVID Could Impact Health Insurance Coverage, Eligibility

The presence of long COVID may spur changes in health insurance coverage, as people with employer-sponsored health plans may have to cut back their hours or stop working, according to data from the Kaiser Family Foundation (KFF).

COVID-19 vaccines and prior infections can help protect individuals against severe illness and death, but experts have yet to determine whether they offer protection against long COVID.

Long COVID can occur after people are infected with COVID-19. Symptoms can include malaise, fatigue, breathing challenges, migraines, cardiovascular abnormalities, and mental health impairments. KFF researchers estimated that 10 to 35 million adults between 18 and 64 may have long COVID.

Although it is unknown how long people with long COVID experience symptoms, one study found that 29 percent of patients were sick for more than one year.

Long COVID can significantly impact employment and health insurance coverage, as the accompanying symptoms can limit people’s ability to work.

Among adults with long COVID who had worked before infection, 25 percent were out of work after getting long COVID and 31 percent reduced their hours.

More than 60 percent of adults receive health insurance coverage through an employer, according to KFF. People with long COVID who can no longer work could lose their existing coverage and experience income losses.

These changes could allow some individuals to qualify for subsidies on the Affordable Care Act (ACA) marketplace, while others may be eligible for Medicaid. However, Medicaid eligibility remains limited in the 12 states that have yet to expand Medicaid under the ACA.

Individuals may also qualify for Medicaid through a pathway that does not use the modified adjusted gross income (MAGI) methodology to determine eligibility, such as age or disability status.

Long COVID also raises the question of whether the illness will be counted as a disability by federal disability programs, including Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI).

The HHS Office for Civil Rights established that long COVID can be counted as a disability under the Americans with Disabilities Act (ADA) if an individual assessment determines that it substantially limits one or more major life activities.

However, SSDI and SSI require applicants to be unable to work and have health conditions that last for at least a year or result in death to qualify for the programs.

Whether or not people with long COVID qualify for federal disability programs can affect healthcare coverage. People eligible for SSDI can qualify for Medicare after a two-year waiting period, while individuals eligible for SSI typically qualify for Medicaid.

“If people with long COVID are unable to work, federal disability programs could play a key role helping those patients access the healthcare they need to recover,” KFF researchers wrote.

The COVID-19 pandemic has had various impacts on health insurance coverage.

For example, data published in JAMA Health Forum found that employer-sponsored health plan coverage fell even as employment rebounded in 2020.

Meanwhile, the individual health insurance marketplace saw enrollment increases during 2020.

Over a third of consumers (35 percent) reported that they were considering switching health plans during open enrollment in 2022 due to the COVID-19 pandemic, according to a ValuePenguin study.