Costs are rising as health insurers require members to pay more for COVID-19 treatment

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health reform. He welcomes questions and suggestions and tip sheets at joseph@healthjournalism.org.

Research shows 72% of large health insurers are now requiring members to share in the treatment costs for COVID-19

Source: Jared Ortaliza, Matthew Rae, Krutika Amin, Matthew McGough and Cynthia Cox, “Most private insurers are no longer waiving cost-sharing for COVID-19 treatment,” (KFF, Aug. 19, 2021), accessed Aug. 20, 2021. Reprinted with permission.Research shows 72% of large health insurers are now requiring members to share in the treatment costs for COVID-19

Here’s another bit of compelling information to share with your audience: New research shows that most health insurers are requiring their members to pay their deductibles, copayments and coinsurance (if any) for COVID-19 treatment.

Until late last year, almost all health insurers did not require their members to share in the cost of COVID-19 treatment, whether they were vaccinated or not.

In recent months, however, as vaccines have become widely available, commercial health insurers have changed their cost-sharing requirements for insured members needing treatment for COVID-19, according to research that KFF and the Peterson Center on Healthcare published recently.

At Axios, Caitlin Owens summed up the issued succinctly. “Coronavirus patients who end up hospitalized — the vast majority of whom are unvaccinated — are increasingly likely to be on the hook for their medical bills, according to a new KFF analysis,” she wrote. Now that patients need to pay their deductibles, co-pays and coinsurance, remaining unvaccinated has become a lot more expensive, she added.

For health care journalists writing about vaccine hesitancy, this is a story we should cover because taken together, the deductible, copayment and coinsurance contribute to what’s called the out-of-pocket maximum. This year, the out-of-pocket maximum for an individual with a marketplace plan could be as high as $8,550, according to Healthcare.gov.

To be clear, the vaccinated and unvaccinated alike will be billed for their share of costs, and those costs vary under each individual health plan. But the mRNA vaccines from Moderna and Pfizer are effective at preventing any illness from the novel coronavirus and extremely effective in preventing the severe illness that leads to hospitalization and death, as Dylan Scott reported at Vox.

For the research, KFF reviewed statements and other policies from commercial health insurers on patient cost-sharing for COVID-19 treatment. The researchers found that 72% of 102 health plans (the two largest insurers in each state and the District of Columbia) were no longer waiving such costs as of Aug. 12. “Almost half these plans (50 plans) ended cost-sharing waivers by April 2021, which is around the time most states were opening vaccinations to all adults,” KFF reported.

The researchers got their numbers from insurers’ websites and from the health insurers’ trade association, America’s Health Insurance Plans.

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