Though many health plans have waived cost-sharing for coronavirus tests, high deductibles may still prevent patients from seeking care.
Kathy Hempstead, senior policy adviser at the Robert Wood Johnston Foundation, wrote in a blog post that this can especially be a challenge for people with plans purchased on the individual markets or the small group markets.
The median deductible for a bronze plan on the Affordable Care Act’s exchange is $6,000, meaning in many cases copayments for tests or office visits wouldn’t kick in until that threshold is met. And that could hinder people from seeking care, Hempstead said.
“I would say the segment described in the blog is an extreme case of a general problem,” Hempstead told FierceHealthcare.
The Health Care Cost Institute estimates the average visit to the emergency department costs $1,100 just to walk in the door. While someone enrolled in a large, self-funded employer plan may see a lower-cost copay, 87% of individual market plans require that the deductible be fully met before cost-sharing kicks in.
For small group plans, 70% require the deductible is met before cost-sharing is available, Hempstead wrote.
“I think that this is probably the thing that people need to address really swiftly so we make sure people don’t feel deterred from seeking care,” she said.
In addition, waiving the costs for medical care may not solve all of the financial concerns associated with the COVID-19 outbreak, such as paid leave or childcare, Hempstead said. However, easing the cost burdens to testing can pull back a financial barrier associated with the outbreak.
The cost challenge highlights the broader issue of how fragmented the healthcare system is, she said. Private health insurers can waive costs for certain markets, while state governments will need to weigh in for Medicaid.
As Medicare is regulated on the federal level, that adds a third wrinkle, Hempstead said.
“There’s no easy and universal way to make this problem go away,” she said.