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      Out-of-Pocket Spending for COVID-19 Hospitalizations in 2020

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      medRxiv

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          ABSTRACT

          IMPORTANCE

          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, including clinician services. Assessing out-of-pocket spending for COVID-19 hospitalizations in 2020 could demonstrate the financial burden patients may face if insurers allow waivers to expire, as many chose to do during early 2021.

          OBJECTIVE

          To estimate out-of-pocket spending for COVID-19 hospitalizations in 2020

          DESIGN

          Cross-sectional analysis

          SETTING

          IQVIA PharMetrics® Plus for Academics Database, a national claims database

          PARTICIPANTS

          COVID-19 hospitalizations for privately insured and Medicare Advantage patients during March-September 2020

          MAIN OUTCOMES/MEASURES

          Mean total out-of-pocket spending, defined as the sum of out-of-pocket spending for facility services billed by hospitals (e.g., accommodation charges) and for professional/ancillary services billed by clinicians and ancillary providers (e.g., clinician inpatient evaluation and management, ambulance transport)

          RESULTS

          Analyses included 4,075 hospitalizations. Of the 1,377 hospitalizations for privately insured patients and the 2,698 hospitalizations for Medicare Advantage patients, 981 (71.2%) and 1,324 (49.1%) had out-of-pocket spending for facility services, professional/ancillary services, or both. Among these hospitalizations, mean (SD) total out-of-pocket spending was $788 (1,411) and $277 (363). In contrast, 63 (4.6%) and 36 (1.3%) hospitalizations had out-of-pocket spending for facility services. Among these hospitalizations, mean total out-of-pocket spending was $3,840 (3,186) and $1,536 (1,402). Total out-of-pocket spending exceeded $4,000 for 2.5% of privately insured hospitalizations, compared with 0.2% of Medicare Advantage hospitalizations.

          CONCLUSIONS

          Few COVID-19 hospitalizations in this study had out-of-pocket spending for facility services, suggesting most were covered by insurers with cost-sharing waivers. However, many hospitalizations had out-of-pocket spending for professional/ancillary services. Overall, 7 in 10 privately insured hospitalizations and half of Medicare Advantage hospitalizations had any out-of-pocket spending. Findings suggest insurer cost-sharing waivers may not cover all hospitalization-related care. Moreover, high cost-sharing for some hospitalizations suggests out-of-pocket burden could be substantial if waivers expire, particularly for privately insured patients. Rather than rely on voluntary insurer actions to mitigate this burden, federal policymakers should consider mandating insurers to waive cost-sharing for all COVID-19 hospitalization-related care throughout the pandemic.

          KEY POINTS
          Question

          How much were patients billed for COVID-19 hospitalizations in 2020?

          Findings

          Of 1,377 and 2,698 COVID-19 hospitalizations for privately insured and Medicare Advantage patients, 71.2% and 49.1% had cost-sharing for facility services billed by hospitals, services billed by clinicians or ancillary providers, or both. Among these hospitalizations, mean out-of-pocket spending was $788 and $277. 4.6% and 1.3% had cost-sharing for facility services; among these hospitalizations, mean out-of-pocket spending was $3,840 and $1,536.

          Meaning

          Insurer cost-sharing waivers for COVID-19 hospitalizations may not cover all hospitalization-related care. Patient out-of-pocket burden could be substantial if insurers allow waivers to expire.

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          Author and article information

          Contributors
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          Journal
          medRxiv
          May 30 2021
          Article
          10.1101/2021.05.26.21257879
          © 2021

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