PUBLISHED THU, APR
9 202011:17 AM EDTUPDATED THU, APR 9 202011:41 AM EDT
KEY POINTS
·
The average cost to
treat a hospitalized patient with coronavirus is $30,000, according to a study.
·
Regardless of the
amount, the tab wouldn’t be picked up entirely by patients with insurance.
·
Even if you don’t have
coverage, you may not end up getting billed for all your treatment due to the
Trump administration’s intention to partially reimburse providers for treating
the uninsured.
The last thing someone who contracts coronavirus
needs to worry about is the cost of treating it.
While legislators, regulators and insurance
companies have taken steps aimed at improving access to care and reducing
expenses, one person’s required share of medical charges could vary wildly from
another patient receiving the same treatment.
Most individuals who come down with the virus
recover at home.
However, an estimated 15% of infected people may
end up hospitalized, according to the Kaiser Family Foundation. Recent
data suggests that patients who go to intensive care stay there for an average of 20
days.
The average cost to treat a hospitalized patient
with the virus is $30,000, according to a study released Wednesday by America’s
Health Insurance Plans, a trade group for insurers. (Other estimates have come
in both lower and higher.)
Regardless of the amount, though, the tab
generally wouldn’t be the responsibility of patients with insurance. And even
for those with no coverage, there’s a good chance — as of now — that you won’t
get billed for at least som eparts of your treatment.
Here’s what you should know.
The uninsured
Although details are still being worked out, the
Trump administration said last week that it will use funding under recently
passed legislation to help cover the cost of treating uninsured coronavirus
patients — as long as the hospital accepting the government’s reimbursement
rate does not bill the uninsured patient for any remaining balance (i.e.,
“balance billing”).
“The uninsured would be able to go into the
hospital without being worried about facing thousands of dollars in hospital
bills,” said Karyn Schwartz, a senior fellow at the Kaiser Family Foundation.
However, it’s unclear whether the government’s
offer of reimbursement extends only to hospitals or to other providers as well,
Schwartz said. That includes physicians who treat a coronavirus patient in the
hospital and may not be directly employed by the facility.
If it does apply to all coronavirus-related
treatment in a hospital, and there’s broad acceptance by providers to accept
the conditions of getting the money, the cost for an uninsured patient could be
next to nothing — meaning they could fare better than some insured patients.
“For a Covid-19 patient whose insurer is not
covering cost-sharing the way some are, they might be somewhat worse off than
an uninsured person who would be getting help from the government,” said Paul
Ginsburg, director of the USC-Brookings Schaeffer Initiative for Health Policy.
There are roughly 28 million uninsured
individuals in the U.S., according to Kaiser. Of those, an estimated 670,000 to
about 2 million will require hospitalization for coronavirus.
Private health
insurance
Not counting any Medicare plans, this category
generally includes employer-based insurance options as well as individual
policies purchased through a health exchange or marketplace.
Although some of the nation’s largest insurers have said they’ll waive
cost-sharing — i.e., deductibles and co-pays — for treatment,
some employer plans can choose not to participate.
Basically, in plans that are “self-funded” —
typically more common among large employers — cost-sharing is determined by the
company, not the insurance carrier.
“You might have, say, an Aetna or United
Healthcare insurance card, but they are just the administrator of the plan and
not the one making the rules,” Schwartz said.
If your employer plan isn’t among those that’s
waiving treatment costs, typical co-pays and deductibles would apply. The
average deductible among employer plans is $1,655. For non-group policies
purchased through an exchange, the deductible typically is higher: more than $4,500 for an individual
and nearly double that for family coverage.
About 157 million people had employer-based
plans as of 2018, according to Kaiser data. Another 20 million had individual
policies.
Medicare and Medicaid
For the 62 million people on Medicare — the
majority of whom are 65 or older, the others younger with disabilities — the
cost for coronavirus treatment would depend largely on whether the beneficiary
has additional insurance beyond basic Medicare (Part A hospital coverage and
Part B outpatient care coverage).
Roughly a third of Medicare recipients have an
Advantage Plan. Many of the plans — which deliver Parts A and B, and typically
prescription drug coverage — have their own cost-sharing structures. Some
insurers who offer those plans have said they will waive treatment costs.
And, regulators have alerted Advantage Plans
that operate in states with emergency declarations in place
that they must cover services at out-of-network facilities (that
participate in Medicare) and charge the in-network rate.
Other beneficiaries pair basic Medicare with a
supplemental policy (i.e., Medigap), which would end up covering much of the
cost-sharing that comes with original Medicare, including deductibles and
co-pays.
However, for those with basic Medicare and no
additional coverage — whether through Medicaid, an employer plan or elsewhere —
the cost-sharing hasn’t changed.
“There’s been no additional protections added
for them,” Schwartz said. “They’re kind of stuck.”
Those recipients would face a $1,408 Part A
deductible when they’re admitted to the hospital, although that covers the
first 60 days of hospitalization.
For patients on Medicaid — roughly 65 million
people whose incomes are low enough to qualify for that program — the
cost-sharing for medical care is typically minimal, although it varies from
state to state.
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