On Oct. 18, JAMA Network Open published an Original Investigation article entitled, “Assessment of Out-of-Pocket Spending for COVID-19 Hospitalizations in the U.S. in 2020,” by Kao-Ping Chua, M.D., Ph.D.; Rena M. Conti, Ph.D.; and Nora V. Becker, M.D., Ph.D.
The authors state that “From August 2020 through July 2021, there were 2.4 million U.S. hospitalizations for COVID-19. To mitigate patient financial burden, many private insurers and Medicaid Advantage insurers voluntarily waived cost-sharing for COVID-19 hospitalizations during part or all of 2020. The literature examining cost sharing for other respiratory infection–related hospitalizations suggests that these waivers potentially resulted in substantial savings for patients. For example, among privately insured patients hospitalized for treatment of respiratory infections between 2016 and 2019, average out-of-pocket spending was $1,653 for those in traditional plans and $1,961 for those in consumer-driven health plans. Among Medicare Advantage patients hospitalized for treatment of influenza in 2018, mean out-of-pocket spending was almost $1,000.”
The authors explain that waivers may have mitigated the financial burden for many patients hospitalized due to COVID-19 during 2020, some still may have been billed if their plans did not implement waivers or if waivers did not capture all hospitalization-related care. Hospitalizations can result in two categories of bills, according to the authors. “The first includes facility services provided by hospitals, such as accommodation and inpatient pharmacy services,” they write. “The second includes services from clinicians and ancillary service providers (hereafter referred to as professional and ancillary services). This category includes clinician services for emergency department and inpatient care as well as ambulance services for transport to the hospital. Although waivers would ideally cover both categories, some may have covered only facility services billed by hospitals, not professional and ancillary services billed separately by professionals providing those services.”
That said, “In May 2021, we conducted a cross-sectional analysis of the IQVIA PharMetrics Plus for Academics database (IQVIA Inc). This database contains fully adjudicated medical and pharmacy claims from deidentified patients in all 50 states and the District of Columbia. Claims were complete through September 30, 2020, at the time of analysis. The database included 1.0 million patients covered by Medicare Advantage plans and 7.7 million patients covered by private plans in 2020, all of which were fully insured plans. Data contributors are a fixed group of plans, the identities of which are confidential. Because data were deidentified, the institutional review board of the University of Michigan Medical School exempted analyses from human participant review. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline for cross-sectional studies.”
The authors state that “In this cross-sectional study of 4,075 COVID-19 hospitalizations in 2020, 71.2 percent of privately insured patients and 49.1 percent of Medicare Advantage patients had cost sharing for any hospitalization-related service, including those billed by clinicians; 4.6 percent of privately insured and 1.3 percent of Medicare Advantage had cost sharing for facility services billed by hospitals, with mean out-of-pocket spending of $3,840 and $1,536, respectively.”
The authors conclude that the study suggests that insurer cost-sharing waivers for COVID-19 hospitalizations may not always capture all hospitalization-related care and the financial burden on patients could be substantial without insurer wavers. The authors say that the increasing trend of no longer providing waivers suggests that relying on voluntary actions by insurers is not an ideal strategy if policy makers want to protect patients from the costs associated with COVID-19 hospitalizations.
The authors conclude that “To achieve this goal, federal policy makers might consider legislation mandating insurers to waive cost sharing for COVID-19 hospitalizations throughout the public health emergency. Such a mandate would ideally include all hospitalization-related care, similar to existing federal mandates that require insurers to fully cover all direct and related costs of COVID-19 testing and vaccines. Future research should include monitoring of patient financial burden resulting from COVID-19 hospitalizations as coverage policies change.”
