Most people with individual or fully insured group health coverage are enrolled in plans that eliminated out-of-pocket costs for COVID-19 treatment during the pandemic, according to an analysis by the Kaiser Family Foundation.
However, more than a third of people in those markets are in plans in which cost-sharing waivers have already expired or are slated to expire by the end of September, exposing plan members to potentially high out-of-pocket costs should they become sick, the analysis found.
While federal legislation requires all private insurance plans to waive cost-sharing, such as copayments, coinsurance and deductibles, for medically necessary coronavirus testing, no legislation mandates that insurers do the same for COVID-19 treatment, save for laws in five states and D.C.
Many health insurers voluntarily committed to absorbing patients' out-of-pocket costs, possibly motivated by high profits recorded amid the pandemic, according to the analysis. Across all individual and fully insured group plans, 88% of people—about 57 million—are in a plan that eliminated patient costs for treatment at some point during the pandemic. Most insurers stamped an expiration date on those waivers.
"This voluntary approach makes it harder for people who get sick with COVID-19 to know what kinds of costs they might incur, and it also means insurers may start or stop these waivers without much notice," said Cynthia Cox, a vice president at the Kaiser Family Foundation.
According to the analysis, 20% of people are in plans where the waiver has already lapsed. For another 16%, the cost-sharing waiver is set to expire by the end of September. Roughly three in four people in the individual and fully insured group markets are in plans in which cost-sharing waivers will expire by the end of the year.
Cox noted that an earlier KFF analysis found that the typical hospitalization for COVID-19 treatment costs $1,300 for people with large employer coverage. People in Affordable Care Act marketplace or small business plans would likely be on the hook for bigger bills since those plans tend to have higher deductibles.
Some insurers extended cost-sharing waivers for treatment beyond initial expiration dates, but it's unclear how long they will continue to do so. Aetna and UnitedHealthcare extended waivers for treatment to Sept. 30 after initially setting earlier expiration dates. Anthem said it would continue to waive treatment costs through the end of the year.
More than 5.5 million people in the U.S. have had COVID-19, while 173,000 have died from the disease, according to a database maintained by Johns Hopkins University. The Centers for Disease Control and Prevention reported that 144 people out of every 100,000 are hospitalized for COVID-19, but the rate is much higher for people age 50 and older.
The Kaiser Family Foundation analysis did not include self-funded employer plans that cover more than 150 million people, because there is no comprehensive data on how many of these plans waived patient costs for COVID-19 treatment.
