COVID-19 Hospitalizations Could Result in High Out-of-Pocket Costs
Although some of the largest insurers have waived their cost sharing requirements, employer-sponsored “self-insured” health insurance plans are not required to adhere to these waivers.
Despite the fact that many insurers have waived their cost-sharing requirements during the coronavirus disease 2019 (COVID-19) pandemic, investigators still say many Americans could face significant out-of-pocket (OOP) costs if they are hospitalized with the virus.
Although some of the largest insurers have waived their cost sharing requirements, the authors did note that employer-sponsored “self-insured” health insurance plans are not required to adhere to these waivers, leaving Americans with high-deductible insurance plans exposed to greater OOP costs.
“Congress is now debating whether or not to require all plans to waive cost sharing related to COVID-19 treatment,” said the study’s lead author Matthew Eisenberg, PhD, in a statement. “Our findings suggest that they might want to take action to broaden cost-sharing waivers to include these self-insured plans, because these out-of-pocket costs are otherwise going to be high for many people.”
Researchers at the Johns Hopkins Bloomberg School of Public Health analyzed OOP costs for hospitalizations due to pneumonia and other respiratory illnesses between January 2016 and August 2019 as a potential indicator for COVID-19-related costs. They found that these costs were especially high for consumer-directed health plans, which typically have lower premiums but higher deductibles.
They analyzed 34,395 unique hospitalizations during the study period and analyzed OOP costs incurred by patients with pneumonia, acute bronchitis, lower respiratory infections, and acute respiratory distress syndrome. The cases did not include patients aged 65 years and older, who are normally covered by Medicare. The OOP costs included deductible payments, co-payments, and coinsurance payments.
For patients with consumer-directed plans, the average OOP spending for these respiratory hospitalizations was $1961, compared with $1653 for patients in traditional, smaller-deductible plans.
The researchers found that the OOP cost gap was lowest for patients aged 56 to 64 years, and greatest ($2237 vs. $1685) for patients 21 years of age and younger. Although the analysis was not designed to examine why this cost gap varied, the authors said it may be because younger patients are healthier on average, and thus their hospitalizations may reflect more serious and costly illnesses.
“For people already struggling with serious respiratory illness due to COVID-19, the added stress of managing large medical bills could be devastating at this moment when so many Americans are experiencing major financial strain and job loss,” said co-author Alene Kennedy-Hendricks, PhD, in a press release. “This is a critical area to watch and to consider for policy action moving forward.”
COVID-19 Hospitalizations Could Mean Significant Out-of-Pocket Medical Costs for Many Americans [news release]. Johns Hopkins Bloomberg School of Public Health; June 15, 2020. https://www.jhsph.edu/news/news-releases/2020/covid-19-hospitalizations-could-mean-significant-out-of-pocket-medical-costs-for-many-americans.html. Accessed June 19, 2020.