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As insurers end grace period for COVID-19 hospital costs, out-of-pocket costs may rise

Flu data from 2018, the closest analog, shows costs for patients could add up to hundreds or even thousands.

Jeff Lagasse, Associate Editor

Nearly 1.7 million times in the past year, Americans have checked into hospitals to get treated for severe cases of COVID-19. And for the most part, that care hasn't cost them anything, the authors of a new study write, thanks to insurance companies and government programs that absorbed the usual costs patients would owe for any other hospital stay.

But as some insurers phase back in those out-of-pocket costs, the study estimates that many people over 65 hospitalized for COVID-19 in 2021 may owe an average of nearly $1,000 after they get out of the hospital due to co-pays, deductibles and coinsurance. A few may owe hundreds or thousands more.

That estimate is based on a new analysis of out-of-pocket costs for influenza-related hospitalizations in 2018 that were paid by people with Medicare Advantage plans, which are Medicare plans run by private insurance companies.

Nearly 40% of Americans over age 65 – who have a high chance of needing hospital-level care if they catch the coronavirus – have the kind of insurance analyzed in the study, "Out-of-Pocket Spending for Influenza Hospitalizations in Medicare Advantage."

Most insurers that offer Medicare Advantage plans currently cover COVID-19 hospitalization costs fully for their Medicare Advantage enrollees, but one of these insurers quietly started to allow cost-sharing for its non-Medicare Advantage enrollees in February. 

This raises concerns that cost-sharing waivers may soon be a thing of the past for many or all patients hospitalized for COVID-19. Insurers may choose to extend their waivers for enrollees with Medicare Advantage and private coverage, but if they don't, patients could well bear a larger financial toll.

WHAT'S THE IMPACT?

Writing in the American Journal of Preventive Medicine, a pair of healthcare researchers from the University of Michigan and Boston University detailed data from 14,278 people hospitalized during one of the worst flu years in recent times.

On average, the flu patients in the study were hospitalized for an average of six days, and one-third of patients needed intensive care. This is around the same or slightly lower than the averages for hospitalized adults over 65 who have COVID-19.

Those who needed intensive care for flu, and those with longer stays at any level of care, faced out-of-pocket costs that were higher than the general average. About 3% of the flu patients faced out-of-pocket costs more than $2,500.

An examination of cost-sharing among people with private non-Medicare insurance who were hospitalized for respiratory infections in pre-COVID-19 times suggests out-of-pocket costs could be even higher for them. In part, this is because so many private plans have high deductibles that must be paid each year before insurance coverage fully kicks in.

The authors said the choice of flu or other respiratory infection hospitalizations is not a perfect stand-in for COVID-19, which is having far more impact on the U.S. than even the worst flu year, but it's as close a stand-in as possible.

People with traditional Medicare also must share in the cost of their hospital care, but the current study did not analyze data from people with that form of coverage.

In 2018, 40% of Americans lacked enough savings to pay for a $400 emergency. The pandemic has put even more economic pressure on the lowest-income Americans.

Authors call for federal legislation mandating insurers to fully cover the costs of COVID-19 hospitalizations for the duration of the pandemic, and for insurers to extend the waivers that are due to expire soon.

THE LARGER TREND

During the most recent Medicare Open Enrollment period, consumers flocked to Medicare Advantage not only for the telehealth benefits, but for COVID-19 supplemental benefits offered by the private plans, a December 2020 analysis showed.

Of those who decided on an MA plan because of supplemental benefits, 35% cited COVID-19 supplemental benefits specifically, while 27% cited telehealth benefits.
 

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com