- Most private payers offered financial relief for COVID-19 treatment, but many of those cost-sharing waivers are set to expire in the next few months, even as the pandemic shows no signs of slowing, a new Kaiser Family Foundation analysis found.
- Nearly nine in ten people enrolled in the individual and fully insured group markets are in plans that have limited out-of-pocket costs for COVID-19 treatment. However, 20% of such waivers in the U.S. have already expired, and another 16% are scheduled to time out by the end of September, meaning just over half of enrollees in the plans will still be free from COVID-19 cost-sharing by October.
- Many insurers have extended the waivers, and others could take that step before theirs expire. But the report raises concerns more privately insured individuals could be exposed to steep medical costs at a time of deep economic and public health instability, even as payers report record profits amid the pandemic.
The coronavirus has swept through the country largely unchecked, leading to 5.6 million confirmed infections and 176,000 deaths to date. It's also sparked a coverage crisis, as tens of millions of Americans lose their jobs and, correspondingly, their health insurance at a time of great medical need.
In the early days of the pandemic, insurers took steps to lessen the financial impact of the coronavirus on their members, waiving coinsurance, copayments and deductibles for COVID-19 treatment and offering premium relief, along with easing access to telehealth.
However, KFF found much of this aid could soon expire even though the need for it hasn't gone away, and could even intensify. The pandemic is gaining steam in many regions of the U.S. and could commingle with a bad flu season this fall, piling up more burden on the country's already stressed healthcare system, public health experts warn.
Congress has attempted some health cost relief: Two major pieces of COVID-19 relief legislation passed in March made COVID-19 testing free for most people, though questions remain about who exactly pays. Some patients have been hit with massive bills for the service, despite the laws.
Congress didn't limit out-of-pocket costs for COVID-19 treatment. Only five states — Massachusetts, New Mexico, Idaho, Michigan and Minnesota — and Washington, D.C., require insurers waive cost-sharing for COVID-19 treatment for fully insured beneficiaries.
KFF previously estimated an inpatient admission for COVID-19 treatment could generate more than $1,300 in out-of-pocket costs for a patient in a large employer-sponsored plan. Costs could be significantly higher for severely sick patients, or for enrollees in individual and small group market plans, which typically have higher deductibles.
A little less than a third of beneficiaries in the individual and fully insured group markets are covered by plans that waived COVID-19 treatment cost-sharing through the end of 2020. Another 15% are in plans that have an unspecified expiration date on the cost-sharing, KFF found.
Only about one in four enrollees in individual and fully insured group market plans are getting some sort of premium relief, KFF estimates, including premium credits or reductions, payment grace periods or expedited medical loss ratio rebates.
If insurers don't spend enough on patient care — including waivers and premium relief — they could be on the hook for steep MLR rebates next year under the Affordable Care Act. Payers reported massive profits due to patients delaying care in the first half of 2020, sparking a House committee investigation.
KFF's analysis of payer lobby America's Health Insurance Plans' and enrollment data did not include the 61% of group market enrollees in self-insured plans through their job, as comprehensive data wasn't available for that cohort. Employers in self-insured plans can opt out of extending cost-sharing and other forms of financial relief for their employees.