Among those people who are hospitalized with COVID-19, more than 95% are unvaccinated. For this reason, many people are worried that their health insurance premiums will go up, just because they choose not to get the vaccine. Can health insurance companies require the COVID-vaccine under threat of higher premiums? The short answer is no, but like all things related to health insurance, it’s a bit more complicated than that. This blog should clear a few things up about health insurance and the COVID vaccine.

Can Health Insurance Companies Require the COVID Vaccine?

Health Insurance and the COVID Vaccine: 5 Questions Answered

Q: Will Health Insurance Companies Require the COVID Vaccine or Raise Rates on the Unvaccinated?

Under the Affordable Care Act (ACA), U.S. health insurance companies are prohibited from using health factors in determining policy prices. The one exception to this rule is whether or not the individual smokes tobacco.

This means that your health insurance company cannot start charging more because you choose to remain unvaccinated.

However, some companies have increased their group policy rates for unvaccinated workers. The biggest example is Delta Airlines, which has increased group policy premiums by $200 for the unvaccinated. Because private companies have some leeway in how much they contribute towards an employee plan, it is not illegal for them to charge more.

Q: Is Insurance Billed for COVID Vaccine?

The COVID-19 vaccine is available to all individuals at zero cost, regardless of insurance or immigration status. These vaccines have been paid for with taxpayer dollars, so there is no case in which you will receive a bill.

IMPORTANT: If a COVID-19 vaccination provider tried to charge you for a vaccine, or a copay or coinsurance for getting the vaccine, it is a SCAM.  

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Q: Does Health Insurance Cover COVID Treatment?

Your health insurance plan only covers what is detailed in the plan’s coverage policy. To put it another way, there is no written requirement that insurance companies cover all costs associated with COVID-19 treatment.

But depending on your plan, you may or may not be covered for COVID costs including:

  • Urgent care or Emergency Room treatment
  • Inpatient hospitalization, including supplies and medications
  • Outpatient services like doctor visits, x-rays, and lab tests

However, most health insurance companies are waiving diagnostic testing fees during the pandemic. You can also get a free COVID test at many pharmacies across the U.S. You can click here to find a community-based testing site for COVID-19.

Q: Will My Health Insurance Premiums Go Up if I Don’t Get the COVID Vaccine?

Under the ACA, your health insurance cannot increase your monthly premium if you don’t get the COVID vaccine. However, if you’re in an employer-sponsored group plan, then you could see increased premiums if you’re not vaccinated.  

Q: How do I Get More Affordable Premiums During the Pandemic?

It doesn’t matter whether you need lower premiums or more comprehensive coverage, we can help. At HSA for America, we pair every one of our clients with a Personal Benefits Manager or PBM). Your PBM is available year-round for friendly, no-cost consultations, for as long as you have your plan.

However, the only time to sign up for a health insurance plan is during Open Enrollment. This is a busy time of year for our industry, so schedule an appointment as soon as you can.

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Disclaimer: The information in this blog is designed for general information purposes only. For the most accurate and updated guidance for COVID-19, visit the Centers for Disease Control and Prevention website. If you’re looking for more information about how COVID-19 might affect your employee rights, the Department of Labor’s Coronavirus Resources page is a good place to start.

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