COVID hospitalization could cost patients thousands of dollars out of pocket

While most COVID-19 hospitalizations leave no out-of-pocket patients, roughly 1 in 20 patients who are commercially insured or with Medicare Advantage will receive thousands of dollars in bills, according to a new study.

In an analysis of 4,300 COVID-19 hospitalizations, 4.6% of privately insured patients received an average of $ 3,800 for services charged by hospitals between March and September 2020, according to a study published Monday in The JAMA network is open. Approximately 1.3% of Medicare Advantage patients saw bills over $ 1,500. The study sheds light on the enormous burden of health care costs that Americans face, as most of the cost-sharing waivers from insurance companies come to an end.

“Your bill could be thousands of dollars if you are hospitalized due to COVID and your insurer no longer covers those hospitalizations,” said lead study author Dr. Kao-Ping Chua, assistant professor of health management and policy at the hospital. University of Michigan School of Public Health.

More than 70% of hospitalized COVID patients with private insurance plans were billed for services related to their stay, including physician services, lab tests, diagnostic imaging, and physical therapy. These services cost patients an average of $ 788. Nearly half of Medicare Advantage patients incurred similar out-of-pocket costs for services related to their hospital stay, averaging $ 277.

Most private and Medicare Advantage insurers have voluntarily waived out-of-pocket costs such as deductions and copayments for COVID-19-related hospitalizations for most of 2020.

By the beginning of this year, some of the largest insurers had lost their equity waiver. A Kaiser Family Foundation analysis in August found that nearly three-quarters of the largest health plans are no longer abandoning the cost sharing of COVID-19 treatments, while another 22% planned to end their abandonments by the end of 2021.

Insurers’ push to end the COVID cost-sharing phase-out has intensified since the vaccine became widely available earlier this year.

The vast majority of COVID-related hospitalizations were among unvaccinated individuals. There were about 287,000 preventable hospitalizations among unvaccinated adults between June and August, costing the health care system and more than $ 5 billion, according to a September report. KFF analysis

As public discontent with those who remain unvaccinated grows, it is unlikely that insurers or the federal government will move to reinstate cost-sharing waiver, says Chua of the University of Michigan.

“The unvaccinated are very unhappy,” Chua said. “Some might think that the bills (unvaccinated individuals) that they might get for their hospitalization are in fact justified because vaccines are widely available.”

Moving away from cost sharing will force those infected with COVID-19, despite being fully vaccinated, immunocompromised and children too young to be vaccinated, to bear this out-of-pocket cost. he said.

“If your goal was to punish the unvaccinated financially, this is not the best way to do it,” Chua said.

Losing bounces by insurers could further exacerbate the current public health crisis caused by the pandemic. High out-of-pocket costs can lead to patients delaying seeking help in case of illness. Delaying care can end up costing the health care system more, as patients are admitted to hospital with more complex conditions requiring more intensive care for treatment.

“In my opinion, the most correct thing would be to restore these failures of insurers,” Chua said. “If not by voluntary actions of insurers, then by a federal mandate.”

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