Blue Cross North Carolina will soon begin charging members for COVID-19 treatment, representing one of the first Blues plans to end its waiver pausing cost-sharing and out-of-pocket expenses for coronavirus care during the public health crisis.
Come April 1, Blue Cross NC's fully-insured and group members will be responsible for all the copayments, coinsurance and deductibles related to their treatment for COVID-19. The North Carolina Department of Insurance declined to comment.
"With the decline of new COVID-19 cases in North Carolina and nationally, the distribution of the COVID-19 vaccine and more effective treatments available, we better understand the costs and the role treatments play in helping our members," a Blue Cross NC spokesperson said in a statement. "Most health plans that had similar measures in place have already ended those measures."
The insurer added that it waived cost-sharing fees for "two to three months longer than many other health plans," although it declined to name other health plans that have already re-enacted cost-sharing for COVID-19 treatment.
Among the other more than 60 nationwide Blue Cross and Blue Shield affiliates that Modern Healthcare reached out to ask when they planned on re-enacting cost-sharing for COVID-19 treatment, Blue Cross NC is one of the the nation's first to send bills back to patients. Blue Cross and Blue Shield of Louisiana ended its waiver pausing cost-sharing for coronavirus care at the start of the year, and Blue Shield of California re-enacted cost-sharing at the beginning of March.
Earlier this month, Blue Cross Rhode Island also announced plans to kickstart its cost-sharing program for coronavirus treatment, although the insurer quickly reversed the decision after pushback from the state's Office of Insurance Commissioner. Rhode Island is the only state where its insurance commissioner also runs a state committee aimed at reducing healthcare costs, said Glenn Melnick, a healthcare finance professor at the University of Southern California. Blue Cross has now paused cost-sharing through the public health crisis for members suffering from the coronavirus.
"Their insurance commissioner has pretty broad authority," Melnick said. "Even if she doesn't have direct authority to stop them from re-introducing this, they don't want to get on her bad side. That may be why they pulled back."
Most Blue Cross insurers have taken the position of Rhode Island and planned on suspending cost-sharing for coronavirus treatment indefinitely.
Congress under the CARES Act mandated that insurers cover all medically necessary testing and vaccine costs related to the public health crisis. The CMS has likewise forced all insurers to cover treatment costs for COVID-19 for Medicare patients. While four states and Washington D.C. have mandated that insurers cover care for patients suffering from coronavirus, federal officials remain silent on the matter. Blue Cross NC appears to be one of the first Blues plans to take advantage of this blindspot.
"My immediate thought is, 'Why would they even do this? The optics are terrible, and the savings are likely to be minuscule,'" Melnick said. "We're not talking about a large, at-risk group. If they're worried about the cost of long-haul COVID patients, you have to think about the other side, which is these are folks that are now going to be subject to a chronic illness. Do you really want to bankrupt them by demanding cost-sharing for services that they have no choice over?"
Indeed, adults 65 and over are at least 10 times more likely to be hospitalized from COVID-19 than younger individuals, according to the Centers for Disease Control and Prevention. Melnick noted that cost-sharing exists to keep premiums down and persuade consumers to think twice before using low-value care. He believes Blue Cross NC should implement a value-based benefits design for coronavirus care and eliminate cost-sharing so as not to dissuade individuals from seeking treatment, and health complications and higher medical costs.
"I think if you actually took a poll and asked somebody, 'Should these insurers let these people continue to get the care they need without having to have out-of-pocket costs?' I'm guessing 90% of all Americans would say, 'Go ahead. If my premium goes up a little bit next year, so be it," Melnick said.
Blue Cross NC could be seeking to pullback some of the benefits enhancements they put in place in the middle of 2020 to offset high minimum-loss-ratios, or MLRs, which is the amount they spend on medical services for their members, said Ari Gottlieb, a principal at the A2 Strategy Group healthcare consultancy. As consumers deferred care in 2020, health insurers added new digital health services, addressed social determinants of health and invested in their administrative operations to avoid being seen as profiting from the pandemic and having to return excessive rebates to members.
"It's likely that they're seeing normal utilization experience this year, so they don't feel the need to subsidize these things," Gottlieb said. "If a regulator is not making them do it, and it's not required by law, why wait?"
Gottlieb said he thinks insurers should continue to pause cost-sharing for COVID-19 treatment until the federal government declares the pandemic over, to avoid being seen as not reactive to the public health emergency. At that point, insurers can say they're transitioning back to business as usual, with the rest of the country.
"Until that point, when they have to cover testing, when they have to cover vaccinations, but they have cost-sharing for treatment, it feels a little bit strange," he said.
