Lost Your Job and Insurance Because of COVID-19 but Need Joint Surgery?

Because of COVID-19, many people have lost their job and with that… their insurance. If you were planning to have joint replacement surgery, this could be especially devastating. Here are 4 things to consider.
May 13, 2020 | 4 min read
Christa S. Plew, MBA
Editor-in-Chief

Since the coronavirus pandemic reared its head in late 2019, over 33 million Americans have filed for unemployment due to total job loss, underemployment, or furlough.1 This loss of income and medical coverage is stressful enough for anyone, even those in their full health.

But, for the thousands of men and women who currently need joint replacement surgery, the financial insecurity caused by COVID-19 has thrown a major wrench in their plans. Couple this with the fact that many surgeons and hospitals around the country recently postponed or canceled elective procedures in order to preserve personal protective equipment, personnel, and hospital beds, and the situation really starts to look painful—no pun intended!

If you've recently lost your job due to the COVID-19 pandemic but need joint replacement surgery because of a painful knee, hip, ankle, shoulder, or other joint, there may be things you can do from a financial standpoint to better prepare yourself for your much-needed procedure.

1. Talk to your health insurance provider

Some health insurance plans are offering discounts and special enrollment periods right now because of COVID-19. Call your insurance provider and ask about their policies surrounding qualifying life events (QLE), which includes loss of coverage due to a job loss.2

Depending on your situation, you may also be eligible for Medicaid, which you can enroll in at any time as long as you meet the eligibility requirements.3

2. Talk to your employer

If you've had health insurance coverage from your job but were let go due to COVID-19, ask your employer about COBRA.4 Known as the Consolidated Omnibus Budget Reconciliation Act, COBRA is a federal law that allows you to keep your job-based health plan for a limited amount of time after losing your job (usually about 18 months). Keep in mind that under COBRA, you have to pay the full premium yourself up to 102 percent4 of the cost to the plan, in addition to some administrative fees.

Is your flex spending account (FSA) overfunded or underfunded because of COVID-19? The Internal Revenue Service is now offering mid-year changes for employer-sponsored plans, so consider asking your employer about this, too.5 You may be able to revoke or change how much pre-tax money you're putting into your FSA—which could help you out significantly, especially if you've put away a lot of money for your elective surgery only to have it postponed indefinitely.

Under the Coronavirus Aid, Relief, and Economic Security (CARES) Act, eligible individuals may also be able to draw up to $100,000 in 401(k) distributions in 2020 without incurring the typical early withdrawal penalty.6 So, you may decide to do this as a way to clear up some extra funds. Just check with your employer first, and keep in mind you'll still owe income tax on the money you withdraw (fortunately, you'll have up to three years to pay it).6

3. Explore grants and loans

Outside of talking with your insurance provider and employer, you still have other options for funding your upcoming joint surgery. For instance, there may be hospitals and facilities in your community that provide free or low-cost medical services for eligible patients as part of the Health Resources and Services Administration (HRSA).7

While many experts caution against taking out more debt right now, many lenders are currently offering low-interest rates on personal loans. Just be sure to read carefully the terms of any loan you're considering and watch out for hidden fees.

4. Ask your surgeon if a referral to physical therapy is appropriate

Research suggests that people who get physical therapy (PT) before joint replacement surgery (sometimes called "prehabilitation") are less likely to be discharged to an inpatient rehabilitation setting after their operation and may save themselves up to 30 percent of their postoperative care needs.8,9 For example, in back surgery, PT has sometimes been shown to increase patient satisfaction and may reduce the risk of postoperative complications and pain.10

In other words: a pre-surgical PT session or two could be a surprisingly cost-effective step to add to your pre-op checklist—if you can fit it into your budget. While it depends on your location and provider, a typical out-of-pocket cost for physical therapy is between $75 and $150 per visit.11 If you do have insurance coverage, this could drop to around $20 to $55 per visit as part of your co-pay.

If you've already exhausted physical therapy and other conservative treatment measures, at least be sure to look at your lifestyle and make improvements where you can. Things like poor diet, smoking, and obesity have all been correlated with poorer outcomes after surgery.12 Even high levels of stress can delay wound healing, increase inflammation, and make your pain feel even worse.13,14

So, while it may sound easier said than done, do your best to make healthy choices now (e.g., diet, sleep, exercise) so that when you are able to finally get your knee, hip, ankle or shoulder replaced, you'll be better prepared for your procedure.

References
  1. Thorbecke, C. (2020, May 7). 3.2 million more people file for unemployment, bringing coronavirus crisis total to over 33 million. ABC News. www.abcnews.go.com/Business/million-people-filed-unemployment-bringing-coronavirus-crisis-total/story?id=70552474.
  2. (n.d.). Qualifying life event (QLE). Healthcare.gov. www.healthcare.gov/glossary/qualifying-life-event/.
  3. Skowronski, J. (2018, Jan 28). A state-by-state guide to Medicaid: Do I qualify? Policy Genius. www.policygenius.com/blog/a-state-by-state-guide-to-medicaid/.
  4. (n.d.). Continuation of health coverage (COBRA). U.S. Department of Labor.  www.dol.gov/general/topic/health-plans/cobra.
  5. Solomon, J. (n.d.). COVID-19 guidance under § 125 cafeteria plans and related to high deducible health plans. Notice 2020-29. Internal Revenue Service. www.irs.gov/pub/irs-drop/n-20-29.pdf.
  6. Ebling, A. (2020, May 6). IRS issues FAQs on COVID-19-related IRA and 401(K) loans & distributions. Forbes. www.forbes.com/sites/ashleaebeling/2020/05/06/irs-issues-faqs-on-covid-19-related-ira-and-401k-loans--distributions/#6ffde9a64589.
  7. Official Website of the U.S. Health Resources & Services Administration. www.hrsa.gov/
  8. Gawel, J., et al. (2013). Does pre-operative physical therapy improve post-surgical outcomes of patients undergoing a total knee and/or total hip arthroplasty? A systematic review. Physiotherapy Practice and Research. 34(1): 9-20. content.iospress.com/articles/physiotherapy-practice-and-research/ppr017.
  9. Snow, R., et al. (2014). Associations between preoperative physical therapy and post-acute care utilization patterns and cost in total joint replacement. The Journal of Bone and Joint Surgery. 96(19). journals.lww.com/jbjsjournal/Abstract/2014/10010/Associations_Between_Preoperative_Physical_Therapy.11.aspx.
  10. (n.d.). Education from a physical therapist before back surgery may reduce cost, improve outcomes. Choose PT. www.choosept.com/didyouknow/detail/education-from-physical-therapist-before-back-surg.
  11. (n.d.). How much does physical therapy cost? Retrieved from thervo.com/costs/physical-therapy-cost.
  12. Eeka, A. and Chen, A. (2015). Patient-related medical risk factors for periprosthetic joint infection of the hip and knee. Annals of Translational Medicine. 3(16). www.ncbi.nlm.nih.gov/pmc/articles/PMC4598452/.
  13. Gouin, J. and Keicolt-Glasier, J. (2012). The impact of psychological stress on wound healing: methods and mechanisms. Immunology and Allergy Clinics of North America. 31(1): 81-93. www.ncbi.nlm.nih.gov/pmc/articles/PMC3052954/.
  14. Hayati, A. and Rahimah Z. (2015). Pain in times of stress. The Malaysian Journal of Medical Sciences. 22(Spec Issue): 52–61. www.ncbi.nlm.nih.gov/pmc/articles/PMC4795524/.
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