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For payers, patients and employees, coronavirus spending could exceed $20,000 for the most serious cases

Since all of the estimates are based on pneumonia, it's likely that costs will be even higher during the coronavirus outbreak.

Jeff Lagasse, Associate Editor

Overall and out-of-pocket healthcare spending is expected to be high as the COVID-19 coronavirus pandemic continues to affect daily life for billions across the globe. Data analyzed by researchers from the Peterson-Kaiser Family Foundation Health System Tracker have attempted to quantify these costs, estimating that the cost of inpatient admissions for COVID-19 treatment could top $20,000.

The authors arrived at that figure by looking at the total cost of treatment for an inpatient admission for pneumonia among large employer plans, based on 2018 figures. With major complications or comorbidity, total costs for admission -- including the amount paid by insurance as well as the amount paid out-of-pocket -- average $20,292.

With minor complications or comorbidity, that number drops to $13,767. Without complications, the amount is $9,763.

WHAT'S THE IMPACT

Of course, people with employer and other private coverage often face a deductible for hospital stays, and across people with employer-sponsored coverage, 82% of covered workers had a deductible, with 55% having a deductible of over $1,000. On average, across people with and without deductibles, the typical deductible in employer sponsored plans is $1,396.

For pneumonia admissions without complications, out-of-pocket costs average $1,464. The numbers are similar for people with major complications, mainly because many people with hospitalizations reach their deductible and/or out-of-pocket max, thus limiting their exposure to the underlying cost.

Since all of those figures are based on pneumonia, it's likely that costs will be even higher during the coronavirus outbreak, and for several reasons.

First, the analysis is based on claims from large employer plans, which tend to be the most generous private plans. Those with private coverage through small businesses or the individual market tend to face higher deductibles; the 75th percentile for out-of-pocket costs for pneumonia, regardless of severity, was a hair over $2,000 in 2018.

Second, the pandemic is occurring early in the calendar year, meaning many people haven't yet amassed much health spending to satisfy their deductibles. Deductible and out-of-pocket spending is concentrated mainly in the months from January to March, while typically employee out-of-pocket spending doesn't reach the average deductible until mid-to-late May. In a normal year, many enrollees never meet their deductible.

Plus, these figures don't include balance billing. Patients often receive surprise medical bills for care even when they go to in-network hospitals. This practice of balance billing is banned by some states.

Some large health insurance companies have assured the public they won't charge higher cost-sharing for people who inadvertently go out-of-network, but only providers would be in a position to halt balance bills. Prior to the COVID-19 pandemic, Congress had considered bipartisan legislation to address surprise billing, but had been met by resistance from both providers and insurers.

THE LARGER TREND

Aside from more general concerns, 69% of close to 600 individual and family health insurance enrollees lack a basic understanding of how testing and treatment of the COVID-19 novel coronavirus would be covered by their health insurance plan, according to a survey released by eHealth.

A similar figure, 64%, say they could not afford to pay out their full annual deductible if hospitalized for treatment of coronavirus.

Meanwhile, the college educated and affluent are better able to make lifestyle adjustments in the face of coronavirus: 52% of college graduates and 60% of those with incomes of $100,000 to $150,000 say they have a job allowing them work from home, compared to 19% of those with a high school education and 36% of those earning less than $25,000 per year.

Twitter: @JELagasse

Email the writer: jeff.lagasse@himssmedia.com