Blog | Coronavirus

Most health plans have stopped waiving cost-sharing for COVID-19 treatments, report finds

Blog | Coronavirus

Most health plans have stopped waiving cost-sharing for COVID-19 treatments, report finds

Researchers with the Kaiser Family Foundation said more and more people likely will receive “significant medical bills” for COVID-19-related care.

As the pandemic has progressed, fewer insurers are waiving patient cost sharing for COVID-19 treatments, a new analysis has found.

Researchers with the Kaiser Family Foundation (KFF) examined the current waiver policies of 102 insurers — the two largest in each state and Washington, D.C. Among that group, 72% are charging out-of-pocket costs for COVID-19 treatment, and another 10% plan to phase out waivers by November (some waivers set to expire in the next two months may end up being prolonged because they’re tied to the end of the public health emergency, which is scheduled to conclude Oct. 17 but could be extended).

“As vaccines have become widely available to adults in the U.S. and healthcare utilization has rebounded more generally, health insurers may no longer face political or public relations pressure to continue waiving costs for COVID-19 treatment,” the authors wrote. “As more waivers expire, more people hospitalized for COVID-19 — the vast majority of whom are unvaccinated — will likely receive significant medical bills for their treatment.”

A big drop-off in waiver availability

The researchers noted that all 102 plans had waived cost sharing for COVID-19 treatments during a portion of the pandemic.

A previous KFF analysis found that 88% of health plan enrollees were absolved of cost-sharing obligations because of health plan waivers that were implemented during the early stages of the pandemic, although waivers had expired for 20% of the enrollees in that group by the time of the August 2020 analysis.

“At the time, health insurers were highly profitable due to lower-than-expected healthcare use, while hospitals and healthcare workers were overwhelmed with COVID-19 patients,” the authors wrote in the new analysis. “Insurers may have also wanted to be sympathetic toward COVID-19 patients, and some may have also feared the possibility of a federal mandate.”

Federal regulations require that COVID-19 testing be provided on demand without cost sharing, but no such directive is in place for treatments except in certain states.

COVID-19 cost-sharing requirements among employers

In interviews conducted by KFF during the first half of 2021 — most by mid-April — 36% of employers reported that cost sharing for COVID-19-related care was not required by their largest insurer. The share was 44% among surveyed employers with 1,000 or more employees, compared with 34% among employers with between 50 and 199 employees.

“Self-funded employers were similarly likely as employers purchasing fully insured plans to offer waivers for COVID-19 cost sharing,” the authors wrote.

However, they noted, “Since this survey was conducted earlier in the year, many of the waivers may have already expired by the time of this report.”

About the Author

Nick Hut

is a senior editor with HFMA, Westchester, Ill. (nhut@hfma.org).

Sign up for a free guest account and get access to five free articles every month.

Advertisements

Related Articles | Coronavirus

News | Payment Trends

Healthcare News of Note: Healthcare insurers owe hospitals billions of dollars in payments and are putting more patients in a bind with retroactive claim denials, says Kaiser Health News

Healthcare News of Note for healthcare finance professionals is a roundup of recent news articles: Insurers are behind in billions of dollars in payments to hospitals, the strain on clinicians and staff grows amid the pandemic, and CFO duties involve more digital activities and investor relations.

News | Strategic Partnerships Mergers and Acquisitions

Healthcare M&A activity for Q3 remains low in volume but high in impact, firms report

The number of M&A transactions involving hospitals and health systems remained at historically low levels, but the average revenue involved was far higher than in recent years.

Column | Coronavirus

Time for another extension of the COVID-19 public health emergency?

Hospitals and other healthcare providers are starting to ask whether it would be prudent and appropriate for the government-declared public health emergency (PHE) to be extended once again.

News | Coronavirus

Q&A: What healthcare professionals can do to stay safe while traveling and attending live events

Mayo Clinic’s Sean C. Dowdy shares best practices healthcare professionals can use to stay safe while traveling and attending live events, and he discusses what Mayo Clinic’s COVID-19 modeling shows for Olmsted County in Minnesota.