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Expiring Waivers Could Mean Big Bills for COVID-19 Patients

Analysis  |  By Alexandra Wilson Pecci  
   June 02, 2021

Without payer cost-sharing waivers, people with job-related or self-purchased insurance could face bills of about $3,800 for a COVID-19 hospitalization.

Many major payers have lifted their cost-sharing waivers for COVID-19 bills, which means people who are hospitalized with COVID-19 this year could be hit with thousands of dollars in medical bills.

That's the conclusion of a new analysis from the University of Michigan, which was published as a preprint and is being submitted for peer review.

Most health insurance companies voluntarily waived co-pays, deductibles, and other cost-sharing for hospitalized COVID-19 patients in 2020, but many lifted those waivers in early 2021.

Using data from real patients hospitalized for COVID-19 last year, the researchers discovered that the lack of waivers could mean bills of about $3,800 for people with job-related or self-purchased insurance, and $1,500 for people with Medicare Advantage plans.

The new study analyzes more than 4,000 COVID-related hospitalizations of people with private insurance and Medicare Advantage insurance between March and September 2020. The data come from the IQVIA PharMetrics Plus for Academics Database, which includes claims data from multiple insurers across the United States.

The researchers found that most patients didn't have to pay for hospital services such as room-and-board changes, suggesting their plans waived cost-sharing for bills sent by hospitals.

However, the few who did have to pay for hospital services (a sign that a waiver wasn't in place) had out-of-pocket costs in the thousands of dollars.

"It is premature for insurers to stop protecting patients from the costs of COVID-19 hospitalizations," lead author Kao-Ping Chua, M.D., Ph.D., a health policy researcher and pediatrician at Michigan Medicine and the Susan B. Meister Child Health Evaluation Research Center, said in a statement.

The study also suggests thar insurer cost-sharing waivers for COVID-19 hospitalizations don't always cover all hospitalization-related care.

For example, patients in the study frequently received bills from the doctors who cared for patients in the hospital as well as from ambulance companies.

Overall, 71% of privately insured patients received a bill for any hospitalization-related service, with an average size of $788. Among those with Medicare Advantage coverage, 49% received a bill, with an average size of $277.

A solution could be policy related: The researchers say that federal policymakers could require insurers to waive costs of COVID-19 hospitalization-related care throughout the pandemic, which they already do for COVID-19 testing and vaccination.

"Even though hospitalization levels are decreasing, more than 20,000 people are hospitalized for COVID-19 in the U.S. right now. The pandemic is not over," Chua said. "Our findings illustrate the potential burden that patients now may face if they are covered by insurers that never implemented cost-sharing waivers or let their waivers expire."

Alexandra Wilson Pecci is an editor for HealthLeaders.

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