Two big commercial
insurers are waiving cost sharing for COVID-19 related treatment, which could
be a big deal for people with Medicare Advantage coverage who need
hospitalization.
Humana and Cigna
announced Sunday the waiver of copayments for treatment of the highly
contagious respiratory disease caused by the new coronavirus, which emerged in
December in China and has spread worldwide. Humana is waiving copays,
regardless of whether the care is provided at an in-network hospital or
doctor’s office; Cigna limited its waiver to in-network medical providers.
“Our customers with
COVID-19 should focus on fighting this virus and preventing its spread,” Cigna
CEO David M. Cordani said in a prepared statement.
Pittsburgh-based
insurer Highmark has waived costs related to testing for the coronavirus, but
hasn’t yet determined whether to waive out of pocket expenses, spokesman Aaron
Billger said Monday in a statement.
“We are working to
ensure a delicate balance of the needs of members, group customers, hospitals
and clinicians to avoid potential cost-shifting that can occur during and after
a health crisis like we have today,” Mr. Billger wrote.
UPMC Health Plan
officials were unavailable.
Most people who get
COVID-19 have minor or no symptoms, but about 5% of cases are critical with
respiratory failure, shock or multi-organ dysfunction. Moreover, middle-age and
older people, especially those with underlying medical problems, are more prone
to get seriously ill and require hospitalization.
People age 65 and
older comprised 53% of the overall admissions to a hospital intensive care unit
for the COVID-19 infection and 45% of all hospitalizations, according to a new
study by the Kaiser Family Foundation. Medicare Advantage plan members could
face thousands of dollars in copayments as the result of a hospitalization for
the virus, for which the only care is supportive.
For a five-day
hospital stay, the average Medicare Advantage member would incur $1,200 in
out-of-pocket expenses, according to the study; a 10-day hospital stay would
mean a member having to pay $2,039.
Virtually all of
the 50 to 60 Medicare Advantage plans being sold require members to kick in
part of the cost of care in the form of copays, said Aaron Zolbrod, founder of
the Health Insurance Store, which has offices in Connellsville and Forest
Hills.
Traditional
fee-for-service Medicare coverage also requires copays for care — if the
member does not carry Medigap coverage.
The Kaiser study
found that 6 million Medicare members have no supplemental coverage, which Mr.
Zolbrod said costs about $90 a month for someone age 65 and covers copays for
care. He estimated the share of people with traditional Medicare coverage
without a Medigap plan at just 11% of the total.
Medicare Advantage
plans have a penetration rate of about 50% in Western Pennsylvania, higher than
the 34% nationwide average, according to the Centers for Medicare and Medicaid
Services.
Virtually all
Medicare Advantage enrollees would pay less than the Part A Medicare hospital
deductible for an inpatient hospital stay of three days. But for five days
or longer, at least half of Medicare Advantage enrollees would pay more, Kaiser
found.
The Medicare
fee-for-service coverage copayments would not apply to members with a Medigap
plan.
“There’s no reason
to go with Medicare only,” Mr. Zolbrod said about the Medigap supplemental
plans. “None.”
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