Abstract
Many insurers waived cost sharing for COVID-19 hospitalizations during 2020. Nonetheless, patients may have been billed if their plans did not implement waivers or if waivers did not capture all hospitalization-related care. Assessment of out-of-pocket spending for COVID-19 hospitalizations in 2020 may show the financial burden that patients may experience if insurers allow waivers to expire, as many chose to do during 2021. To estimate out-of-pocket spending for COVID-19 hospitalizations in the US in 2020. This cross-sectional study used data from the IQVIA PharMetrics Plus for Academics Database, a national claims database representing 7.7 million privately insured patients and 1.0 million Medicare Advantage patients, regarding COVID-19 hospitalizations for privately insured and Medicare Advantage patients from March to September 2020. Mean total out-of-pocket spending, defined as the sum of out-of-pocket spending for facility services billed by hospitals (eg, accommodation charges) and professional and ancillary services billed by clinicians and ancillary providers (eg, clinician inpatient evaluation and management, ambulance transport). Analyses included 4075 hospitalizations; 2091 (51.3%) were for male patients, and the mean (SD) age of patients was 66.8 (14.8) years. Of these hospitalizations, 1377 (33.8%) were for privately insured patients. Out-of-pocket spending for facility services, professional and ancillary services, or both was reported for 981 of 1377 hospitalizations for privately insured patients (71.2%) and 1324 of 2968 hospitalizations for Medicare Advantage patients (49.1%). Among these hospitalizations, mean (SD) total out-of-pocket spending was $788 ($1411) for privately insured patients and $277 ($363) for Medicare Advantage patients. In contrast, out-of-pocket spending for facility services was reported for 63 hospitalizations for privately insured patients (4.6%) and 36 hospitalizations for Medicare Advantage patients (1.3%). Among these hospitalizations, mean (SD) total out-of-pocket spending was $3840 ($3186) for privately insured patients and $1536 ($1402) for Medicare Advantage patients. Total out-of-pocket spending exceeded $4000 for 2.5% of privately insured hospitalizations compared with 0.2% of Medicare Advantage hospitalizations. In this cross-sectional study, few patients hospitalized for COVID-19 in 2020 were billed for facility services provided by hospitals, suggesting that most were covered by insurers with cost-sharing waivers. However, many patients were billed for professional and ancillary services, suggesting that insurer cost-sharing waivers may not have covered all hospitalization-related care. High cost sharing for patients who were billed by facility services suggests that out-of-pocket spending may be substantial for patients whose insurers have allowed waivers to expire.
Highlights
From August 2020 through July 2021, there were 2.4 million US hospitalizations for COVID-19.1 To mitigate patient financial burden, many private insurers and Medicaid Advantage insurers voluntarily waived cost sharing for COVID-19 hospitalizations during part or all of 2020.2,3 The literature examining cost sharing for other respiratory infection–related hospitalizations suggests that these waivers potentially resulted in substantial savings for patients.[4,5,6] For example, among privately insured patients hospitalized for treatment of respiratory infections between 2016 and 2019, average out-of-pocket spending was $1653 for those in traditional plans and $1961 for those in consumer-driven health plans.[4]
In this cross-sectional study, few patients hospitalized for COVID-19 in 2020 were billed for facility services provided by hospitals, suggesting that most were covered by insurers with cost-sharing waivers
We explored whether it was reasonable to assume that hospitalizations with out-of-pocket spending for facility services were not covered by insurers with cost-sharing waivers for these services
Summary
From August 2020 through July 2021, there were 2.4 million US hospitalizations for COVID-19.1 To mitigate patient financial burden, many private insurers and Medicaid Advantage insurers voluntarily waived cost sharing for COVID-19 hospitalizations during part or all of 2020.2,3 The literature examining cost sharing for other respiratory infection–related hospitalizations suggests that these waivers potentially resulted in substantial savings for patients.[4,5,6] For example, among privately insured patients hospitalized for treatment of respiratory infections between 2016 and 2019, average out-of-pocket spending was $1653 for those in traditional plans and $1961 for those in consumer-driven health plans.[4]. Hospitalizations can result in 2 categories of bills.[7,8] The first includes facility services provided by hospitals, such as accommodation and inpatient pharmacy services. The second includes services from clinicians and ancillary service providers (hereafter referred to as professional and ancillary services). This category includes clinician services for emergency department and inpatient care as well as ambulance services for transport to the hospital. Waivers would ideally cover both categories, some may have covered only facility services billed by hospitals, not professional and ancillary services billed separately by professionals providing those services
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