The development and approval of a vaccine for COVID-19 is a huge step in the right direction of tackling this pandemic. However, until a vaccine is widely available and even beyond, COVID-19 testing is likely to stay front and center. So, what are the costs associated with COVID-19 testing? Who pays? What about the monstrous COVID-19 hospital bills? In this post, we give answers to frequently asked questions about the costs and insurance coverage associated with COVID-19.
The good news is that most insurance plans or government-sponsored programs should cover the cost of COVID testing.
In March, the federal government passed the Families First Coronavirus Response Act (FFCRA), requiring all forms of public and private insurance, even self-funded plans, to cover FDA-approved COVID-19 tests and any costs associated with testing, for the duration of the public health emergency.
What’s more, there is no limit on how many COVID-19 tests an insurer or plan must cover for an individual, as long as each test is deemed medically appropriate and the patient has symptoms of COIVD-19, or has had known or suspected exposure to SARS-CoV-2 recently. SARS-CoV-2 is the virus that causes COVID-19.
The Coronavirus Aid, Relief, and Economic Security (CARES) Act expanded protections by requiring private plans to cover out-of-network tests fully as well. The CARES Act requires health plans to reimburse out-of-network COVID-19 test claims at up to the cash price that the provider has posted on their public web site.
According to FairHealth, the total average charge per COVID-19 patient requiring an inpatient stay is $73,300
Nationally, the median charge amount for COVID-19 inpatient care for people without insurance or who went out of network was $45,683 for people aged 51 to 60 and $34,662 for those aged 23 to 30.
Unlike federal law coverage for COVID-19 testing, there has not been any sweeping legislation to limit the cost of COVID-19 treatment. Factors that influence how much COVID-19 treatment costs include how severe each person’s case is, length of hospital stay, and what kind of insurance coverage they have.
While there is currently no curative treatment for COVID-19, severe cases require hospitalization, which can become extremely expensive.
Private health insurance: Experts estimate that inpatient services would cost about $38,000 for commercially insured patients. Although some of the nation’s
(deductibles and co-pays) for treatment, some employer plans are choosing not to participate. If your employer plan isn’t one of the companies that is waiving treatment costs, typical co-pays and deductibles will apply. The average deductible among employer plans is $1,655. For non-group policies purchased through an exchange, the deductible typically is higher: more than $4,500 for an individual and nearly double that for family coverage.
Medicare and Medicaid: For the 62 million people on Medicare, coronavirus treatment costs will depend primarily on whether the beneficiary has additional insurance beyond basic Medicare (Part A hospital coverage and Part B outpatient care coverage). About a third of Medicare recipients have an Advantage Plan. Many of the plans that deliver Parts A and B, and typically prescription drug coverage have their own cost-sharing structures. Some insurers who are offering those plans have said they will waive treatment costs.
Uninsured: Uninsured people who need treatment for COVID-19 may be able to access free services. If they don’t find free services, they may be left with thousands and thousands of dollars in treatment costs. Surprise treatment costs are also popping up more frequently. One woman was shell-shocked when she received a bill for $52,112 for her helicopter ambulance ride to the hospital for COVID-19 complications. Last year, Congress worked to pass legislation to eliminate surprise billing. Unfortunately, the efforts stalled, and before Congress could resume negotiations on a plan, the COVID-19 global pandemic began. Though Congress did not allocate any money specifically for COVID-19 treatment or coverage for uninsured people, the Trump Administration did set aside an unspecified portion of the funding for hospitals and other providers included in
for this reason. The Trump administration said it would use funding under recently passed legislation to help cover the cost of treating uninsured coronavirus patients, as long as the hospital accepting the government’s reimbursement rate does not “balance bill” the patient. Balance billing is when a hospital bills a patient for any remaining balance.
It’s no secret that COVID-19 is wreaking havoc on the global economy and the job market alike. Unemployment rose higher in three months of COVID-19 than it did in two years of the Great Recession. Layoffs, struggling industries, and people losing employer-sponsored health insurance due to layoffs are factors that will lead many Americans not to be able to afford COVID-19 treatment, no matter how bad their lives depend on it. There is good news, though, because hospital bills for uninsured COVID-19 patients are covered. This is because the CARES act allows healthcare providers to be reimbursed for COVID-19 testing, treatment, and vaccines for uninsured patients. NPR found that a lot of physicians are simply not informing their patients about this and that some doctors don’t even know about the program or how it works. There’s also no requirement for hospitals to let uninsured patients with COVID-19 know that their bills are covered through a program of the Centers for Medicare and Medicaid Services set up by the CARES Act, and so many providers do not.
Private insurance: As scientists inch closer to developing and getting a vaccine approved, lawmakers have said that the vaccine should be priced fairly and reasonably. When a COVID-19 vaccine is approved and made widely available, millions of Americans with health insurance will be able to get the COVID-19 vaccine at no additional cost. This is due to the bipartisan Coronavirus Aid, Relief, and Economic Security (CARES) Act passed by Congress in March that would make a COVID-19 vaccine a “preventive health service,” which means health plans must cover the entire cost.
Medicaid/Medicare: According to CMS, Medicare beneficiaries will receive FDA-approved coronavirus vaccines for free. The new policy calls for providers to get the vaccine at no cost and for Medicare to reimburse for the cost of administering the injection. Additionally, the policy calls for most private health insurance plans as well as state Medicaid agencies to cover a vaccine without cost-sharing—at least while the pandemic is ongoing.
Uninsured:The cost of a COVID-19 vaccine for uninsured patients is covered under the CARES Act.
How historic job losses will affect health coverage, COVID-19 treatment
Nearly 60% of non-elderly Americans get their health coverage through their employer. The current economic downturn due to the coronavirus pandemic is not only causing millions of people to lose their jobs, but also potentially leaving them without insurance at a time when health coverage is especially critical. Newly uninsured people need to know that there are coverage options available for them. Take a look at current healthcare costs, providers, and recommendations here. Open enrollment is currently going on. For a guide to what you need to do to sign up for the ACA exchange in your state, click here.