Health Insurance

Nearly 36 Million Americans Who Tested Positive for COVID-19 Report Having Long COVID Symptoms — Including More Than 40% in Mississippi

Nearly 36 Million Americans Who Tested Positive for COVID-19 Report Having Long COVID Symptoms — Including More Than 40% in Mississippi

Most health insurance plans will cover medical expenses related to long COVID, but the extent of coverage varies depending on the plan purchased.
A woman suffering from long COVID symptoms.
A woman suffering from long COVID symptoms. Source: Getty Images

The Biden administration plans to end the COVID-19 emergency declaration on May 11, 2023, after another extension in January. For many, COVID-19 has persisted long past their positive tests. In fact, nearly 36 million Americans who’ve had COVID-19 say they’ve had long COVID — symptoms lasting three months or longer.

We looked at where long COVID is most prevalent — and which demographics are most likely to say they’ve experienced long-lasting symptoms. Additionally, stick around for tips on how consumers can utilize their health insurance to minimize costly doctor visits and treatments.

Key findings

  • Nearly 36 million Americans who received a positive COVID-19 test or diagnosis from a health care provider say they had symptoms lasting three months or longer. That equates to 28.8% among those who’ve tested positive. Drilling deeper, 36.4% of Americans who tested positive for COVID-19 and had symptoms for at least three months say it reduced their ability to carry out day-to-day activities.
  • Lower-income Americans who tested positive for COVID-19 are more likely to say their symptoms have lasted longer. 41.2% of COVID-19 positive people who make less than $35,000 annually report having long COVID symptoms, compared with 17.4% who make $200,000 or more a year. The percentage decreases as income level brackets climb.
  • Younger Americans report long COVID at a higher rate than older Americans, but the latter group more often cites reduced abilities to do day-to-day tasks. 30.4% of COVID-19 positive 18- to 24-year-olds report long COVID symptoms, compared with 23.4% of those 65 and older. But 44.9% of the 65-and-older group cite a reduced ability on day-to-day tasks because of their symptoms, versus 28.2% in the 18-to-24 range.
  • Mississippi, Montana and Arkansas have the highest rate of COVID-19 positive people reporting they had symptoms for at least three months. In those states, at least 35% of COVID-19 positive people reported this, including 41.2% in Mississippi. Inversely, Mississippi has the lowest rate of Americans who completed their primary vaccine series (whether one or two shots) at 57.1%.
  • Maine, New Hampshire and Vermont have the lowest rate of COVID-19 positive people reporting they had symptoms for at least three months. In those states, less than 23% of COVID-19 positive people reported this, with Maine (21.8%) being the lowest. Vermont has the highest rate of Americans with their primary vaccine series at 87.5%.

Nearly 36 million Americans suffer from long COVID

Long COVID (COVID-19 symptoms lasting three months or longer) has affected nearly 36 million Americans who received a positive COVID-19 test or diagnosis from a health care provider. That’s 28.8% of Americans who’ve tested positive.

Most people with COVID-19 recover within four weeks, according to the Centers for Disease Control and Prevention, though many continue to recover for between four and 12 weeks. Those with long COVID — also known as post-COVID-19 syndrome or post-acute COVID syndrome — could have any of the hundreds of symptoms people report experiencing, some of which can be debilitating.

According to a study published in December 2022 by Nature Medicine, there are four main subtypes of long COVID, each with a set of symptoms that target a specific system:

  • The first subtype impacts the cardiac and renal (kidney) systems
  • The second subtype impacts the respiratory system, with symptoms also causing sleep and anxiety problems
  • The third subtype impacts the musculoskeletal and nervous systems
  • The fourth subtype impacts the digestive and respiratory systems

According to the findings, the first subtype impacting cardiac and renal systems was the most common, with 34% of patients falling into this category. Closely following that, 33% of patients had the second subtype, experiencing respiratory symptoms, anxiety, lingering headaches and insomnia. Meanwhile, 23% of patients had the third subtype and 10% had the fourth.

Our study indicates how debilitating these symptoms can be: 36.4% of Americans who tested positive for COVID-19 and had symptoms for at least three months say it reduced their ability to carry out day-to-day activities.

Long COVID comes with complicated symptoms that are hard to diagnose and require many expensive tests. A report from Orem, Utah-based Nomi Health estimates that long COVID results in an average of $9,500 in medical costs in the six months following a diagnosis. The report also found that Americans with long COVID are 3.6 times more likely to miss work, resulting in significant financial risk.

Lower-income Americans are more likely to experience long COVID

Some demographic groups are more likely to say they experience long COVID symptoms than others. Particularly, lower-income Americans who tested positive for COVID-19 are more likely to say their symptoms have lasted longer than higher-income consumers.

Among those who make less than $25,000 annually, 41.2% of COVID-19 positive people report having long COVID symptoms — the most of any income group. That compares with 17.4% of those who make $200,000 or more a year — the least of any income group. Notably, the prevalence of long COVID consistently decreases as income bracket levels increase.

Despite the differences, those who contract long COVID may find that the symptoms don’t discriminate by income. The percentage of those with long COVID who say they have a reduced ability to carry out their day-to-day activities is fairly even between the highest and the lowest earners — 35.2% for those earning $200,000 or more, compared with 34.2% of those earning less than $25,000 annually.

Percentage of Americans with long COVID symptoms (by income)

Household income
% of positives with symptoms lasting 3 months or longer
% with reduced ability to carry out day-to-day activities
Less than $25,00041.2%34.2%
$25,000 to $34,99934.1%40.3%
$35,000 to $49,99931.8%41.8%
$50,000 to $74,99931.6%37.2%
$75,000 to $99,99926.7%42.2%
$100,000 to $149,99926.4%34.1%
$150,000 to $199,99919.3%41.2%
$200,000 and above17.4%35.2%

Source: ValuePenguin analysis of Week 51 (Nov. 2 to 14, 2022) U.S. Census Bureau Household Pulse Survey data — the latest available at the time of our research.

According to ValuePenguin health insurance expert Divya Sangameshwar, there are a few reasons why lower-income Americans may be more likely to experience long COVID symptoms.

"Long COVID could be especially devastating for lower-income Americans, who may not have advantages like the option for remote work, a good health insurance plan they can rely on to get care or paid time off," she says. "The stress of making ends meet, a lack of adequate care and working while sick could all contribute to the length of symptoms for lower-income Americans."

Younger Americans report long COVID at a higher rate than older Americans

Overall, younger Americans are more likely to report long COVID symptoms than younger Americans. Among 18- to 24-year-olds, 30.4% of COVID-19 positive Americans report long COVID symptoms. That compares with 23.4% of those 65 and older.

However, older Americans are more likely to report a reduced ability to do day-to-day tasks. Among the 65-plus group, 44.9% cite a reduced ability on day-to-day tasks because of their symptoms. Meanwhile, 28.2% of those in the 18-to-24 range say similarly.

Percentage of Americans with long COVID symptoms (by age)

Age
% of positives with symptoms lasting 3 months or longer
% with reduced ability to carry out day-to-day activities
18 to 2430.4%28.2%
25 to 3928.6%31.4%
40 to 5430.7%37.6%
55 to 6430.1%42.1%
65 and above23.4%44.9%

Source: ValuePenguin analysis of Week 51 U.S. Census Bureau Household Pulse Survey data.

According to a July 2022 study conducted by researchers at Touro University and its affiliated New York Medical College, young adults were more likely to socialize and less likely to wear masks early in the pandemic before vaccines were available, meaning they were generally more likely to contract COVID-19. Because a higher rate in this age group tested positive for COVID-19 than older adults 65 and older, they had a greater chance of contracting long COVID.

However, younger people are generally better at bouncing back from illnesses than older Americans. So although they’re more likely to contract long COVID, their strong immune systems mean long COVID likely wouldn’t affect their day-to-day lives as much as it would affect older Americans.

Where long COVID is most — and least — prevalent

Just as long COVID is more prevalent in some demographic groups, it’s also more prevalent in some states than others. In fact, Mississippi has the highest rate of COVID-19 positive people reporting they had symptoms for at least three months, at 41.2%. That’s followed by Montana (35.1%) and Arkansas (35.0%).

Sangameshwar believes that the lower-than-average COVID-19 vaccination rates and low median incomes in Mississippi, Montana and Arkansas could contribute to their high long COVID rates.

Indeed, Mississippi has the lowest rate of Americans who completed their primary vaccine series (whether one or two shots), at just 57.1%. Meanwhile, 70.1% of residents in Montana have completed their primary vaccine series — among the bottom 20 states. And 60.9% of residents in Arkansas have completed theirs — ranking 48th.

All three states also have median household incomes lower than the U.S. average of $69,021:

  • Mississippi: $49,111
  • Montana: $60,560
  • Arkansas: $52,123

On the other hand, Maine has the lowest rate of COVID-19 positive people reporting they had symptoms for at least three months, at just 21.8%. That’s followed by New Hampshire (22.8%) and Vermont (22.9%).

Like the states with the highest rates of long-COVID, those with the lowest have high rates of residents who’ve completed their primary vaccine series. In fact, Vermont has the highest rate, with 87.5% of its residents having completed their primary vaccines. New Hampshire ranks sixth by state — at 81.7% — while Maine ranks 11th (at 79.0%).

While the median household income in two of the three states is lower than the U.S. average, they’re all still higher than in the lowest-ranking states:

  • Maine: $63,182
  • New Hampshire: $83,449
  • Vermont: $67,674

Full rankings: States where long COVID is most prevalent

Rank
State
% of Americans with long COVID
1Mississippi41.2%
2Montana35.1%
3Arkansas35.0%
4Alabama34.7%
5Wyoming34.5%
6Indiana34.3%
7South Dakota33.5%
8West Virginia33.3%
9Kentucky33.1%
10Oklahoma32.9%
11Wisconsin32.7%
12Nevada32.4%
Show All Rows

Source: ValuePenguin analysis of Week 51 U.S. Census Bureau Household Pulse Survey data.

Full rankings: States with the highest percentage of COVID-19 vaccinated Americans

Rank
State
% vaccinated (primary COVID-19 series)
1Vermont87.5%
2Massachusetts85.1%
3Hawaii84.2%
4Maryland84.1%
5Connecticut82.5%
6New Hampshire81.7%
7Rhode Island81.5%
8New York81.2%
9California80.9%
10Virginia80.4%
11Maine79.0%
12New Jersey78.9%
Show All Rows

Source: ValuePenguin analysis of Week 51 U.S. Census Bureau Household Pulse Survey data.

Long COVID and health insurance: What to know

Long COVID can be damaging to consumers’ health, but it doesn’t necessarily have to be debilitating to wallets. Sangameshwar says most health insurance plans will cover medical expenses related to long COVID, but the extent of coverage varies depending on the plan purchased. Here’s a quick breakdown:

  • Affordable Care Act-compliant private health insurance, employer-sponsored health insurance, Medicare and Medicaid will cover all the general categories of care you may need for long COVID. "That includes inpatient and outpatient care, mental health care, rehabilitation services and prescription drugs," she says. "For private health insurance and Medicare, your out-of-pocket costs could vary. With Medicaid, your out-of-pocket costs will be very low."
  • If you have short-term health insurance or a health-sharing plan, consumers could run into coverage problems if they have long COVID. "Since these plans aren’t regulated by the ACA, many of them come with exclusions for preexisting conditions — and many of these plans classify long COVID as a preexisting condition," she says. "Short-term plans also exclude services that long COVID patients need, such as prescription drugs and mental health care."
  • A claim could be denied if a consumer’s care doesn’t comply with their plan’s rules. "It’s important to note that all health insurance claims are subject to review by the health plan and depending on the plan," she says. "There may be requirements like prior authorization, staying in network and needing a referral from a primary care physician.

Methodology

ValuePenguin researchers analyzed data from Week 51 — Nov. 2 to 14, 2022 — from the U.S. Census Bureau Household Pulse Survey, the latest available at the time of research.

Researchers ranked states and demographics by the highest rate of respondents who received a positive COVID-19 test or diagnosis from a health care provider and reported having symptoms lasting at least three months. They also analyzed the rate of these Americans who said their symptoms reduced their ability to carry out day-to-day activities.