Long COVID and Health Insurance: What You Need to Know
Key takeaways:
Many types of health insurance — including Medicare, Medicaid, employer-sponsored plans, and Affordable Care Act (ACA) marketplace plans — cover the cost of treatment for long COVID-19.
Depending on your health insurance plan, though, you may have substantial out-of-pocket costs associated with your long-COVID treatment.
Long COVID is now considered a disability under the Americans with Disabilities Act (ADA), which may help you access disability benefits regardless of your health insurance status. You may also qualify to enroll in long-COVID clinical trials.
Table of contents
Months to years after a COVID-19 infection, some people continue to experience a wide spectrum of symptoms. Collectively, these symptoms are known as long COVID.
Long COVID symptoms can range from mild to debilitating. For millions of people, this means living with lingering health challenges that require them to have ongoing medical care.
Many health insurance plans cover some or all of the costs associated with treating long COVID. And some people qualify for disability benefits with a long-COVID diagnosis.
If you’ve been diagnosed with long-COVID and you have health insurance — or expect to have it in the future — find out how your coverage could affect your treatment costs.
What is long COVID?
Long COVID, or “long-haul COVID,” is often called the pandemic after the pandemic. The term describes having symptoms after a COVID infection that last at least 4 weeks. But symptoms and health complications from long COVID may endure for months or even years.
As the pandemic progressed and more people emerged with enduring illness, long COVID came to be defined by more than 200 symptoms. Over time, researchers have tried to narrow these down to a more definitive list.
According to a study published in May 2023 in the Journal of the American Medical Association, the 12 most common symptoms people with long COVID have 6 months after getting COVID are:
Fatigue
Post-exertional malaise (symptoms that get worse after physical or mental effort)
Brain fog
Dizziness
Gastrointestinal symptoms
Heart palpitations
Changes in sexual desire or capacity
Loss of taste or smell
Thirst
Chronic cough
Chest pain
Abnormal movements, including tremors, slowed or rigid movements, or sudden, uncontrollable, and jerky movements
As many as 1 in 3 adults with a previous COVID infection could develop long COVID. Given the scale of the COVID pandemic, long COVID is likely to continue to cause healthcare issues for many people for years to come. In fact, CDC estimates indicate that about 6% of U.S. adults are living with long COVID as of mid-June 2023.
About 16% of U.S. adults report that they have experienced long COVID, according to the latest figures from an ongoing study by the National Center for Health Statistics and the U.S. Census Bureau.
What are your health insurance options if you have long COVID?
People with long COVID — a chronic condition — often face high medical expenses and medical debt, as well as disruptions in their ability to work. For people with employer-sponsored health insurance, being unable to work and losing your job can imperil your coverage.
If you have long COVID, your health insurance options may include:
Medicare
Medicaid
Employer-sponsored health insurance
Affordable Care Act (ACA) marketplace plans
Military insurance and Veterans Affairs (VA) healthcare
Medicare
Medicare may be your best option if you’re at least 65 years old or you have a qualifying disability or condition, such as end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS). If you’re old enough to qualify for Medicare or Medicare Advantage, that coverage will come in handy if you stop working and lose your insurance at work.
Medicaid
You may qualify for Medicaid because of your income or long COVID symptoms. This coverage can help if you stop working and lose your employer-sponsored health insurance. Most people with Medicaid or Children’s Health Insurance Program (CHIP) coverage are currently entitled to treatment for COVID, including long COVID.
Employer-sponsored health insurance
About half of the U.S. population is covered by an employer-sponsored health plan. Many of these plans cover health care associated with long COVID, but there can be some cost-sharing. These out-of-pocket costs could be significant, depending on your plan.
Many people with long COVID can no longer work. If this is the case for you, you may qualify for COBRA health insurance in the months after leaving your job.
If your company has at least 50 employees, you could be eligible for protections under the Family and Medical Leave Act (FMLA). The FMLA requires companies to provide up to 12 weeks of unpaid leave per year, if you can’t work for health reasons. During this time, your employer is required to continue offering you group health benefits.
Or, if you have long COVID and you’re age 25 or younger, you may be able to join a parent’s employer-sponsored plan.
ACA marketplace plans
An ACA marketplace plan is another option for people even if you have long COVID. ACA plans cannot deny coverage because of a previous or current health condition, so long COVID doesn’t affect eligibility. And people who lose their employer-sponsored health insurance because they’re no longer able to work qualify for a special enrollment period for ACA coverage.
If you have long COVID and you’re age 25 or younger, you may be able to join a parent’s ACA plan.
Military insurance and VA benefits
TRICARE is a healthcare program for current or retired U.S. military service members and their families. These beneficiaries also qualify for direct care at military hospitals.
The U.S. Department of Veterans Affairs (VA) has published a guidebook on long COVID to help veterans with the condition. Veterans may qualify for care and services through VA healthcare programs.
Can I get disability benefits for long COVID?
The U.S. Department of Health and Human Services (HHS) and the U.S. Department of Justice (DOJ) has categorized long COVID as a potential disability under the Americans with Disabilities Act (ADA).
You may qualify for monthly disability benefits from the U.S. Social Security Administration to replace lost income related to long COVID. To qualify for Social Security Disability Insurance (SSDI), you will need to be unable to work for at least 1 year because of your condition.
To receive SSDI, you must provide evidence that your long COVID is severe enough to substantially limit one or more major life activity, such as:
Working
Walking
Standing
Recalling necessary things
Caring for yourself
In addition to health insurance, long COVID may also qualify you for job-based disability benefits, such as:
Short-term disability payments
Long-term disability payments
FMLA benefits
Workers’ compensation
What if I don’t have health insurance?
If you’re dealing with long COVID and you don’t have health insurance, you may face unaffordable healthcare costs that could lead to medical debt. If you don’t qualify for Medicaid, Medicare, or a low-cost ACA plan, you may have some free or low-cost healthcare options.
You may also be able to find assistance through advocacy and support groups, such as the Long-COVID Alliance and the COVID-19 Longhauler Advocacy Project.
Will my employer provide workplace accommodations for long COVID?
If you have long COVID that qualifies as a disability under the ADA, your employer must provide you with reasonable accommodations if requested. Your employer may be willing to accommodate you even if you don’t technically qualify for disability.
Workplace accommodations can be anything that helps you do your job, including:
Flexible work hours
Remote work
Workstation modifications
Special technology
Federal law generally protects you from workplace discrimination because of a disability. If you believe your rights have been violated, you can file a charge of discrimination with the U.S. Equal Employment Opportunity Commission (EEOC) or the fair employment agency in your state or territory.
Long COVID research
In 2022, the Biden administration ordered the HHS to continue long-COVID research. And the health agency released two reports on the condition later that year. The National Institutes of Health (NIH) also has a $1.15 billion initiative aimed at studying long COVID, including in clinical trials. The studies are intended to improve long-COVID care.
In addition to the options above, you may be eligible to enroll in a long-COVID clinical trial that provides healthcare.
The bottom line
If you have long COVID-19, you may be able to get health coverage through Medicare, Medicaid, employer-sponsored insurance, or an Affordable Care Act (ACA) health plan. If you’re uninsured, you may qualify for other free or low-cost options.
It’s also possible that your lingering long COVID symptoms will make you eligible for disability benefits, including Social Security Disability Insurance (SSDI).
Why trust our experts?
References
ADA.gov. (2020). Guide to disability rights laws.
American Civil Liberties Union. (n.d.). Know your rights: Disability rights.
Batiste, L. C. (2021). Workers with long COVID-19: You may be entitled to workplace accommodations. U.S. Department of Labor Blog.
Casey, L. (2023). Long Covid is a disability. Here’s how to ask for workplace accommodations. The Wall Street Journal.
Centers for Disease Control and Prevention. (2023). Long COVID or post-COVID conditions.
Christensen, J. (2022). Long Covid-19 may remain a chronic condition for millions. CNN Health.
COVID.gov. (n.d.). Health care coverage and access.
COVID-19 Longhauler Advocacy Project. (n.d.). Homepage.
HealthCare.gov. (n.d.). Special enrollment period (SEP).
Konish, L. (2023). Successfully applying for social security disability is difficult. Applying as a long Covid patient is even trickier. CNBC.
Lovelace, B., Jr. (2023). Long Covid patients face medical debt after insurance denies claims. NBC News.
Medicare.gov. (n.d.). End-stage renal disease (ESRD).
Medicare.gov. (n.d.). I’m getting Social Security benefits before 65.
Medicare.gov. (n.d.). Medicare and coronavirus.
Morbidity and Mortality Weekly Report. (2023). Long COVID and significant activity limitation among adults, by age — United States, June 1-13, 2022, to June 7-19, 2023. Centers for Disease Control and Prevention.
Morris, A. (2023). What is long covid? For the first time, a new study defines it. The Washington Post.
National Center for Health Statistics. (2023). Long COVID. Centers for Disease Control and Prevention.
National Institutes of Health. (2021). NIH launches new initiative to study “long COVID”.
National Institutes of Health. (2023). NIH launches long COVID clinical trials through RECOVER Initiative, opening enrollment.
Nova, A. (2023). Here’s what people with long Covid need to know about navigating health insurance. CNBC.
Office of Public Affairs. (2021). DOJ and HHS issue guidance on ‘long COVID’ and disability rights under the ADA, section 504, and section 1557. U.S. Department of Justice.
RECOVER. (n.d.). Homepage.
Thaweethai, T., et al. (2023). Development of a definition of postacute sequelae of SARS-CoV-2 infection. Journal of the American Medical Association.
TRICARE. (2023). Getting care during COVID-19.
U.S. Department of Health and Human Services. (2021). Guidance on “long COVID” as a disability under the ADA, Section 504, and Section 1557.
U.S. Department of Health and Human Services. (2022). Biden-Harris administration releases two new reports on long COVID to support patients and further research.
U.S. Department of Labor. (n.d). Family and Medical Leave Act (FMLA).
U.S. Department of Veterans Affairs. (2022). Whole health system approach to long COVID.
U.S. Department of Veterans Affairs. (2023). VA health care.
U.S. Social Security Administration. (n.d.). Disability benefits | How you qualify.
