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People with insurance could pay over $1,300 for COVID-19 treatment

People with insurance could pay over $1,300 for COVID-19 treatment

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Out-of-pocket costs for pneumonia treatment at hospitals hint at what people may pay

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Amid Dire Predictions of Virus Spread, Hospitals Prepare to Be Inundated
Photo by Barry Chin/The Boston Globe via Getty Images

Someone with health insurance from their employer could pay $1,300 or more out of pocket for treatment if they’re hospitalized with a severe case of COVID-19, the disease caused by the novel coronavirus, according to one analysis. Health researchers based that prediction off of the costs associated with hospitalization for pneumonia.

“The thought is, how we treat pneumonia is going to look at lot like how we treat the coronavirus,” said Matthew Rae, associate director for the Program on the Health Care Marketplace at the Kaiser Family Foundation, who worked on the analysis. “Both are respiratory illnesses.”

The new coronavirus is spreading through the US, and several states have made emergency declarations. The World Health Organization has declared it a pandemic. Here are the basics:

Rae and his co-authors analyzed a database of insurance claims for people enrolled in employer insurance plans. They found that the total cost of treatments for people on those insurance plans who were hospitalized with severe pneumonia with complications was, on average, around $20,000 — though it ranged from around $11,000 to around $24,000. Insurers covered most of that cost, but the out-of-pocket expense for most people usually reached or exceeded $1,300.

The analysis, though, only captured the costs associated with an insurance plan. “It doesn’t capture out-of-network billing charges,” Rae says — also known as surprise medical bills, which can happen when a doctor who isn’t in a patient’s insurance network stops by to see the patient. Around 18 percent of people with severe pneumonia end up with a surprise medical bill.

The costs for pneumonia treatment may not map exactly onto the costs for COVID-19 treatment. It doesn’t include the costs of protective equipment and isolation, for instance. “Those things will make it more expensive,” Rae says. It’s hard to estimate those costs, he says, because there isn’t much data in insurance claims databases that includes them.

This analysis would only apply to patients who are insured through employer plans, which tend to have low deductibles and be fairly generous. People insured with Affordable Care Act plans may face different out-of-pocket costs, Rae says. “It could really range,” he says. “But I wouldn’t say that it would be magnitudes different.”

For people who aren’t insured, though, the cost could be significantly higher. Around 8 percent of people in the US don’t have insurance.

Policies and legislation enacted in response to the pandemic might affect costs of COVID-19 treatments. Insurance companies agreed to waive co-pays for testing, and the bill currently before Congress includes free testing, regardless of insurance status. The White House originally said that insurance companies would cover the cost of treatment in full, but the insurance lobby clarified that they would not be doing so. The insurance companies also said there would not be surprise medical bills associated with COVID-19 treatment, but Rae says it’s not clear how that would work because those charges are made by hospitals and doctors.

“It’s all an open question,” he says. “We’re just trying to take our best guess right now.”

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