While most COVID-19 hospitalizations don't leave patients with out-of-pocket charges, approximately one in 20 commercially insured or Medicare Advantage patients will rack up thousands of dollars in bills, according to a new study.
In an analysis of 4,300 COVID-19 hospitalizations, 4.6% of privately insured patients were billed an average of $3,800 stemming from "facility" services charged by hospitals between March and September 2020, according to a study published Monday in JAMA Network Open. Approximately 1.3% of Medicare Advantage patients saw bills of more than $1,500. The research shines a light on the huge health cost burden facing Americans as most cost-sharing waivers from insurers come to an end.
"Your bill could be in the thousands of dollars if you're hospitalized for COVID and your insurer no longer covers the cost of those hospitalizations," said lead study author Dr. Kao-Ping Chua, assistant professor of health management and policy at the University of Michigan School of Public Health.
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More than 70% of hospitalized COVID patients with private insurance plans were billed for services related to their stay, including clinician services, laboratory tests, diagnostic imaging and physical therapy. Those services cost patients an average of $788. Nearly half of Medicare Advantage patients incurred similar our-of-pocket costs for services related to their hospital stay at an average cost of $277.
Most private and Medicare Advantage insurers voluntarily waived out-of-pocket costs like deductibles and co-pays for COVID-19-related hospitalizations through most of 2020.
By early this year several of the largest insurers let their cost-sharing waivers lapse. A Kaiser Family Foundation analysis in August found nearly three-quarter of the largest health plans no longer waived cost sharing related to COVID-19 treatment, while another 22% planned to end their waivers by the end of 2021.
The push by insurers to end cost-sharing waivers for COVID has picked up since the widespread availability of a vaccine earlier this year.
The vast majority of the COVID-related hospitalizations have been among unvaccinated individuals. Between June and August, approximately 287,000 preventable hospitalizations among unvaccinated adults occurred that costs the healthcare system and more than $5 billion, according to a September KFF analysis.
As public resentment against those who remain unvaccinated has grown, it's less likely that insurers or the federal government will move toward re-instating cost-sharing waivers, University of Michigan's Chua said.
"There's a lot of anger at the unvaccinated," Chua said. "Some may think that the bills (unvaccinated individuals) may receive for their hospitalization are actually justified because vaccines are widely available."
Eliminating the cost-sharing waivers would force those who get COVID-19 despite being fully vaccinated, the immunocompromised, and children too young to get the vaccine to incur those out-of-pocket costs. he said.
"If it was your goal to penalize the unvaccinated financially, this is not the best way to do it," Chua said.
The loss of insurer waivers could further exacerbate the current public health crisis being caused by the pandemic. High out-of-pocket costs could cause patients to delay seeking care when they get sick. Delaying care could end up costing the healthcare system more as patients come into the hospital with more complicated conditions that require more intensive care services to treat.
"In my mind the right thing to do is to reinstate those waivers by insurers," Chua said. " If not via voluntary actions by insurers, then through a federal mandate."
