News Briefs Archive

How Much Out-of-Pocket Spending Will COVID-19 Require?

March 25, 2020

The overall and out-of-pocket health-care spending for coronavirus treatment will be high, researchers from the Peterson-Kaiser Family Foundation Health System Tracker have confirmed, according to reporting by Kelsey Waddill in Healthpayer Intelligence.

The Families First Coronavirus Response Act made some headway in ensuring universal coverage for coronavirus testing, but gaps remain in covering treatment, leaving patients and employers wondering what their overall coronavirus-related costs will be.

To identify potential costs of coronavirus treatment, researchers with the Peterson-Kaiser Family Foundation Health System Tracker compiled the total costs of pneumonia treatment, which, like COVID-19, is a respiratory disease.

The researchers tracked costs for three diagnosis-related groups: one group with no comorbidities or complications, one with complications or comorbidities, and one with major complications or comorbidities.

The researchers found that, generally, the employer and patient in the most costly group—pneumonia patients with serious complications or comorbidities—saw a wide range of potential costs. The twenty-fifth percentile paid $11,533 and the seventy-fifth percentile paid $24,178.

Thus, while the average cost for someone with serious complications was $20,292, the actual costs could be a little over half that price, depending on the patient and her condition.

For those with less serious complications, the cost was closer to $13,767 and those with no complications or comorbidities paid on average $9,763 for treatment.

Next, the researchers outlined how much of those costs fell on employees and how much was covered by their employer-sponsored health plan. Employee costs encompass deductibles, copays, and coinsurance.

Most employees (82 percent) have a deductible. On average, the typical employer-sponsored health plan deducible is nearly $1,400. For pneumonia patients without complications, the out-of-pocket healthcare spending for pneumonia was $1,464—meaning that the patient would shoulder approximately 95 percent of the healthcare costs.

That being said, while $1,400 may be the average deductible for large health plans, many patients have higher deductibles, with the seventy-fifth percentile paying over $2,000. Small businesses and the individual market can have even higher deductibles.

Furthermore, because the pandemic hit the US in the first quarter of the new plan year, coronavirus will be the first medical bills that most patients have on their deductible—meaning that they will likely have to pay the full deductible to cover their coronavirus-related healthcare spending.

On average, the researchers found that coronavirus patients can expect to see around $1,300 out-of-pocket healthcare spending or more. However, given the potential for higher deductibles and the timing of this pandemic, the costs could be far higher.

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