Under applicable federal law, all private insurance plans are required to cover the entire cost associated with approved COVID-19 testing provided the test is deemed medically appropriate. The U.S. government has also paid for COVID-19 vaccines with no out-of-pocket costs regardless of whether the vaccine recipient is insured or not. But there has been no requirement that out-of-pocket treatment costs be waived.
Fair Health, an independent nonprofit focused on enhancing price transparency of healthcare costs and health insurance information, reported that the average billed charge for a complex COVID-19 hospitalization with complexities in the United States is $317,810. The average estimated allowed amount was $98,139 or 31% of the average amount charged. The comparable median amounts were $208,136, $70,098, and 34%. The following table includes the reported costs for general hospitalizations and cases where there was no hospitalization.
|Median Charge Amount||Average Charge Amount||Median Estimated Allowed Amount||Average Estimated Allowed Amount|
“Earlier in the pandemic, [the Kaiser Family Foundation] found that the vast majority (88%) of people enrolled in fully-insured private health plans … would have had their out-of-pocket costs waived if they were hospitalized with COVID-19. At the time, health insurers were highly profitable due to lower-than-expected health care use, while hospitals and health care workers were overwhelmed with COVID-19 patients. Insurers may have also wanted to be sympathetic toward COVID-19 patients, and some may have also feared the possibility of a federal mandate to provide care free-of-charge to COVID-19 patients, so they voluntarily waived these costs for at least some period of time during the pandemic. [Kaiser’s] subsequent analysis found that several of these insurers were starting to phase out COVID-19 cost-sharing waivers by November 2020.
“Across the two largest health plans in each state and D.C. (102 plans), 73 plans (72% of 102 plans) are no longer waiving out-of-pocket costs for COVID-19 treatment. Almost half these plans (50 plans) ended cost-sharing waivers by April 2021, which is around the time most states were opening vaccinations to all adults. Of the 29 plans still waiving cost-sharing for COVID-19 treatment, 10 waivers are set to expire by the end of October. This includes waivers that tie to the end of the federal Public Health Emergency, which is currently set to expire on October 17, 2021, though may be extended. Another 12 plans state that their cost-sharing waivers will expire by the end of 2021. Two plans specified end dates for COVID-19 treatment waivers in 2022 and 5 plans did not specify an expiration date.
“All of the 102 plans [Kaiser] reviewed (two largest plans in each state) had waived cost-sharing for COVID-19 treatment at some point since 2020. (These health plans represent 62% of enrollment across the fully insured individual and group markets).”
Clearly the medical costs of COVID-19 are vast. To date, a large percentage of that cost has been borne by plans and the U.S. Government with little cost to plan participants. We expect to see that change with patients being billed for some of these charges, necessitating rigorous patient protections.