Vaccinations, Variable Risk Lead Payers to End COVID Waivers

by Peter Johnson

Health insurers have begun to phase out the COVID-19 treatment cost-sharing waivers that they have had in place for most of the pandemic. As vaccines have become broadly available in the U.S., insurers are starting to see the novel coronavirus as a "normal" disease.

Background:

• During most of 2020 and the first half of this year, most carriers took on the full cost of COVID-19 treatment for their fully insured members, waiving copays and other cost sharing. Many self-funded employer plan sponsors did the same. However, both types of health plans have begun to make COVID-19 care a normal health benefit with standard hospitalization and outpatient cost sharing applied.
• According to an Aug. 19 report from the Kaiser Family Foundation (KFF), "72% of the two largest insurers in each state and DC (102 health plans) are no longer waiving these costs, and another 10% of plans are phasing out waivers by the end of October."
• The end of carriers' cost-sharing waivers suggests that COVID-19 will become an endemic disease, says Michael Lutz, a senior consultant at Avalere Health.

Plan sponsors imposes health plan surcharge:

• Employers have begun to require their on-site workers to get vaccinated or be terminated. Delta Air Lines Inc. announced on Aug. 25 that employees who do not get vaccinated by the end of October will pay an additional $200 per month in premiums for their health plan and be required to take regular COVID-19 tests.
• Trevis Parson, chief actuary for health and benefits at Willis Towers Watson, says that employer risk for COVID treatment is tough to quantify with or without cost sharing. Parson says that trying to find out how much it would cost to treat the average COVID-19 patient "is a great question, and it's a simple one. But it's got a really complicated answer."
• "The other variable is those that were vaccinated early. We've heard a lot about infections piercing the vaccine," Parson says, though he adds that breakthrough infections have perhaps gotten "a lot of airtime" they don't deserve.

From Health Plan Weekly