LULU GARCIA-NAVARRO, HOST:
As more Americans are infected with coronavirus and develop COVID-19, there are worries beyond recovering from the disease. What if you’ve lost your job and your health insurance? If you’re hospitalized, what will it cost you? As NPR’s Patti Neighmond found out, new laws require insurance companies to pay for testing but not for treatment.
PATTI NEIGHMOND, BYLINE: For the majority of people who get COVID-19, symptoms are likely to be mild to moderate and can be treated by bed rest and isolation at home. But it can be a different story for those who suffer severe pneumonia. Researcher Cynthia Cox with the Kaiser Family Foundation.
CYNTHIA COX: If someone gets very sick and needs to be hospitalized, those costs could be very high.
NEIGHMOND: To get an idea of just how high, Cox analyzed medical claims from 18 million patients with insurance from their employer who were hospitalized in 2018 with pneumonia. Overall, costs ranged from just under $10,000 to just over $20,000. Insurance covered most of that. But patients still had to pay.
COX: We’ve seen the average out-of-pocket costs for pneumonia hospitalizations exceed $1,300.
NEIGHMOND: And that could be on the low end.
COX: We’re still learning about, for example, the most severe cases and how they’re treated. And it could be that people who need a ventilator and have much more severe cases than a typical pneumonia could have even higher costs than this.
NEIGHMOND: At least one insurance company, Aetna, is now waiving copayments and will not count COVID-19 treatments toward the deductible for patients admitted to hospitals it contracts with. It’s not clear whether other insurers will follow suit. Still, Cox says people could be hit with surprise medical bills.
COX: This is where you may do your best to go to an in-network hospital, but one of the doctors who sees you at that hospital does not participate in your plan’s provider network.
NEIGHMOND: And this is typically something patients have no control over.
COX: And what’s happened is that, sometimes, those out-of-network providers will send a bill directly to the patient and ask them to pay for any amount that the insurance company refuses to.
NEIGHMOND: These are bills that can vary dramatically.
COX: We’ve heard some horror stories of people receiving very large surprise bills in the tens of thousands of dollars.
NEIGHMOND: Cox estimates that 1 in 5 pneumonia patients admitted to hospitals will face unexpected out-of-network charges. In many cases, they can be appealed. And with record numbers of Americans being laid off as social isolation is required and businesses close, many are losing their health insurance. Some may qualify for Medicaid, which pretty much covers all medical costs. People still earning some income can buy insurance through the Affordable Care Act. Economist Anh Nguyen with Carnegie Mellon University says the most generous ACA plans cover the majority of medical bills. But the cheaper ones don’t.
ANH NGUYEN: The lowest option, the least generous option of the ACA would cover on average 60% of your medical expenditure.
COX: Which could leave the patients, she says, with a bill of $2,000 or more.
NGUYEN: For low-income family who make maybe $40,000 per year, $2,000 a medical bill is a significant amount.
NEIGHMOND: Older adults are at highest risk for being hospitalized with coronavirus. Those on Medicare typically have supplemental insurance, which covers most medical costs. But without supplemental coverage, they, too, could be hit with high bills. Patti Neighmond, NPR News.
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