It would never be good timing for a pandemic.
But with COVID-19 beginning its spread in the first months of the year, it could be especially unfortunate for patients with high deductibles who catch the virus, according to a new analysis from the Peterson-KFF Health System Tracker, a partnership between the Peterson Center on Healthcare and the Kaiser Family Foundation.
Most people have not accrued much health spending to satisfy their deductibles this early in the year.
And with the cost of hospital admissions for patients who develop pneumonia with major complications—one of the most serious potential problems caused by the novel coronavirus—topping $20,292 for insured individuals, COVID-19 could become pricey for patients.
The analysis used a sample from the IBM MarketScan Commercial Claims and Encounters Database, which includes claims from 18 million people enrolled in large employer plans in 2018. The overall costs for those with less serious complications or comorbidities could be near $14,000, and those with no complications could see costs of nearly $10,000 for inpatient expenses.
Patients with private coverage often face a deductible for hospital stays, and, across those individuals with and without deductibles, the typical deductible in employer-sponsored plans is about $1,400. For patients with hospital admissions for pneumonia without major complications, total out-of-pocket costs, including deductibles, copayments and coinsurance, are on average about $1,464.
"Medical costs are already a common concern in the U.S., particularly for people without insurance, those with high deductibles, and those in worse health," the authors said. "In the context of the COVID-19 pandemic, it is of even greater concern, as many people could be incurring high out-of-pocket costs, at a time when there is also risk of a recession."
Surprise billing is also more likely, the analysis found.
Nearly 1 in 5, or 18%, of patients who have in-network admissions for pneumonia with major complications or comorbidities face out-of-network charges. In comparison, 15% of patients admitted into an in-network facility for all other medical conditions received an out-of-network charge.
While insurers have committed to mitigating the costs associated with COVID-19 testing, they also scrambled to clarify they are not picking up the tab for treatment as President Donald Trump said during an address to the nation last week. America’s Health Insurance Plans, the industry’s leading lobbying group, pointed FierceHealthcare toward a meeting with insurer executives at the White House where Vice President Mike Pence said insurers would waive cost-sharing for coronavirus tests and expand coverage for treatment.
Currently, there is no antiviral or vaccine for the coronavirus that has spread throughout much of the U.S., but people can get treatment for the symptoms of the virus.