May 18, 2022

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What you need to know about health insurance and vaccination status

Your vaccination status won’t affect your ability to obtain health insurance through work or on state-backed exchanges.Those who still haven’t gotten the COVID-19 shot have the Affordable Care Act to thank for that protection, says Emily Langdon, a benefits attorney at law firm Fraser Stryker.”So you can’t say ‘no, because you’re not vaccinated, we won’t let you be eligible for coverage,'” she said. “Because they have to provide coverage.”Under the ACA a company with 50 or more employees must provide health insurance to its workers and their dependents.But spouses are a different story, and Langdon does have some clients who are dropping spouses of employees from health insurance eligibility if they are not vaccinated.For businesses, it’s about the bottom line.”Well, individuals who are not vaccinated are much more likely to get COVID-19, which could mean definitely higher health costs,” Langdon said. “We’ve got ICU stays, and things like that.”From June through August 2021, the Kaiser Family Foundation tracked hospital costs for unvaccinated patients at $5.7 billion. Study after study from medical researchers show the vaccines, from Pfizer, Moderna and Johnson and Johnson can provide up to 85% protection against hospitalization in those who contract COVID-19.But just because a workplace or health insurance provider can’t deny you coverage based on vaccination status, it doesn’t mean unvaccinated workers won’t pay more.About half of Langdon’s clients are exploring or planning COVID-19 wellness programs.”They’re looking and they’re saying this is available, so we’re going to implement this program and if you’re not vaccinated by the end of the year and provide proof, you’re going to have higher health care costs,” she said.Many companies already included flu vaccination or smoking cessation programs in their wellness plans, with incentives for healthy behavior. Delta Airlines was the first large company to announce surcharges on those who refused vaccination in the pandemic. Unvaccinated employees at the airline face $200 monthly surcharges on their health insurance premiums.In the weeks following implementation of the levy, the airline said it achieved 90% vaccination across its workforce. So as millions of Americans enter open enrollment season to sign up for their health insurance benefits for the first time during the pandemic with widespread access to a free and safe vaccine, Langdon says they shouldn’t be surprised to see some changes.”Whether it’s, ‘OK, you get a surcharge if you’re not vaccinated or you get an incentive if you are,’ it’s really the same thing,” she said. “Whether it’s carrot or stick.”Under federal law, those surcharges or incentives based on wellness programs can be up to 30% of the premium price.The question about vaccination status and health insurance only pertains to workplaces that haven’t already mandated the COVID-19 for their workers. Vaccination as a condition of employment is a separate issue, and attorneys have explained case law supports those mandates.

Your vaccination status won’t affect your ability to obtain health insurance through work or on state-backed exchanges.

Those who still haven’t gotten the COVID-19 shot have the Affordable Care Act to thank for that protection, says Emily Langdon, a benefits attorney at law firm Fraser Stryker.

“So you can’t say ‘no, because you’re not vaccinated, we won’t let you be eligible for coverage,'” she said. “Because they have to provide coverage.”

Under the ACA a company with 50 or more employees must provide health insurance to its workers and their dependents.

But spouses are a different story, and Langdon does have some clients who are dropping spouses of employees from health insurance eligibility if they are not vaccinated.

For businesses, it’s about the bottom line.

“Well, individuals who are not vaccinated are much more likely to get COVID-19, which could mean definitely higher health costs,” Langdon said. “We’ve got ICU stays, and things like that.”

From June through August 2021, the Kaiser Family Foundation tracked hospital costs for unvaccinated patients at $5.7 billion. Study after study from medical researchers show the vaccines, from Pfizer, Moderna and Johnson and Johnson can provide up to 85% protection against hospitalization in those who contract COVID-19.

But just because a workplace or health insurance provider can’t deny you coverage based on vaccination status, it doesn’t mean unvaccinated workers won’t pay more.

About half of Langdon’s clients are exploring or planning COVID-19 wellness programs.

“They’re looking and they’re saying this is available, so we’re going to implement this program and if you’re not vaccinated by the end of the year and provide proof, you’re going to have higher health care costs,” she said.

Many companies already included flu vaccination or smoking cessation programs in their wellness plans, with incentives for healthy behavior.

Delta Airlines was the first large company to announce surcharges on those who refused vaccination in the pandemic. Unvaccinated employees at the airline face $200 monthly surcharges on their health insurance premiums.

In the weeks following implementation of the levy, the airline said it achieved 90% vaccination across its workforce.

So as millions of Americans enter open enrollment season to sign up for their health insurance benefits for the first time during the pandemic with widespread access to a free and safe vaccine, Langdon says they shouldn’t be surprised to see some changes.

“Whether it’s, ‘OK, you get a surcharge if you’re not vaccinated or you get an incentive if you are,’ it’s really the same thing,” she said. “Whether it’s carrot or stick.”

Under federal law, those surcharges or incentives based on wellness programs can be up to 30% of the premium price.

The question about vaccination status and health insurance only pertains to workplaces that haven’t already mandated the COVID-19 for their workers. Vaccination as a condition of employment is a separate issue, and attorneys have explained case law supports those mandates.