In 2020, most health insurance providers eliminated co-pays, deductibles, and other cost-sharing for COVID-19 patients who were hospitalized, but several large insurers lifted the waivers in early 2021. In the rise of instances that have occurred since early 2021, tens of thousands of Americans have been very ill and have received hospital or emergency care. According to the report, the lack of waivers might result in expenditures of around $3,800 for persons with job-related or self-purchased private insurance, and $1,500 for people with Medicare Advantage plans, based on data from actual patients hospitalized for COVID-19 last year. Between March and September 2020, the new study examines over 4,000 COVID-19-related hospitalizations among patients with private insurance and Medicare Advantage. The information comes from the IQVIA PharMetrics Plus for Academics Database, which contains claims information from a variety of insurers across the United States.
The researchers discovered that the vast majority of patients were not required to pay for hospital services such as room and board, implying that their insurance plans waived cost-sharing for hospital expenditures. Out-of-pocket charges for the few patients who had to pay for hospital care – a hint that a waiver wasn’t in place – ran into the thousands of dollars. The amount billed to patients directly is a minor percentage of the average cost of care for a COVID-19 patient in a hospital. According to the report, each hospitalization for a person with private insurance costs on average $42,200, while each hospitalization for a person with COVID-19 who has Medicare Advantage coverage costs on average $21,400. The findings were first released as a preprint by Chua and his colleagues in June 2021. Since then, the Kaiser Family Foundation has evaluated the status of exemptions from each state’s two main insurers, finding that 72 percent have stopped their waivers for COVID-19 hospitalizations by August of this year. Patients were occasionally stuck with costs even with waivers. Patients sometimes got bills from physicians for seeing patients in the hospital or were occasionally charged with ambulance bills, according to Chua, even when there appeared to be a waiver in place. A charge for any hospitalization-related treatment was received by 71% of privately insured patients, with an average bill size of $788. A bill was sent to 49 percent of people with Medicare Advantage coverage, with an average amount of $277. Chua believes some patients were improperly invoiced for services from doctors and ambulances because insurers applied for their exemptions incorrectly or healthcare providers did not identify all components of the care as being relevant to COVID-19.
To avoid patients skipping COVID-19-related care because of expenses, Chua suggested that federal officials force insurers to waive COVID-19 hospitalization-related care costs during the pandemic, just as they do for COVID-19 testing and vaccine. However, he emphasized that policymakers are unlikely to do so due to prevalent anti-vaccination sentiment. It’s not simply the hospital and ambulance fees that are a source of stress. Some patients, especially those who have spent a large amount of time in an ICU, may need to be transferred to skilled nursing facilities for additional recuperation. Others have developed comorbidities and may require oxygen therapy — yet another COVID-19-related expense. It’s true that not just the hospitalization, but also the aftermath, can be financially disastrous. Hospitals that have received special pandemic financing are already prohibited from invoicing patients directly for charges that are not covered by their insurance. When hospitals treat uninsured COVID-19 patients, they are reimbursed by the federal government. Chua and colleagues also released a report recently that looked at out-of-pocket costs for patients over 65 in Medicare Advantage plans who were hospitalized for influenza as a way to predict possible COVID-19 out-of-pocket spending. According to the study, the average cost of an influenza hospitalization was roughly $1,000.
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