To get a sense of the likely cost burden on patients hospitalized for COVID-19, Eisenberg and colleagues examined de-identified insurance claims for 34,395 unique hospitalizations from January 2016 through August 2019. They looked at out-of-pocket costs incurred by people who had been hospitalized during the 2016-2019 study period with pneumonia, acute bronchitis, lower respiratory infections, and acute respiratory distress syndrome. (Claims data on actual COVID-19 cases were not available in the database at the time of the study.) The cases examined did not include those for people ages 65 and over, who are normally covered by Medicare. The out-of-pocket costs included deductible payments, copayments, and coinsurance payments.

The researchers found that average out-of-pocket spending for the 2016-2019 study period for these respiratory hospitalizations was $1,961 for patients with consumer-directed plans versus $1,653 for patients in traditional, usually smaller-deductible plans.


The out-of-pocket cost gap was lowest for older patients age 56 to 64, and greatest--$2,237 vs. $1,685--for patients 21 and younger. The analysis was not designed to examine why the cost gap varied inversely with patient age, but one possible explanation proposed by the researchers was that, since younger patients are healthier on average, their hospitalizations may reflect more serious and thus more costly illness.

"For people already struggling with serious respiratory illness due to COVID-19, the added stress of managing large medical bills could be devastating at this moment when so many Americans are experiencing major financial strain and job loss," says study co-author Alene Kennedy-Hendricks, PhD, assistant scientist in the Department of Health Policy and Management at the Bloomberg School. "This is a critical area to watch and to consider for policy action moving forward."

Given that self-insured plans cannot be regulated at the state level, the researchers suggest that federal policymakers should consider waiving COVID-19 cost sharing for self-insured plan policyholders. They note too that while the likely out-of-pocket costs would be greatest for people enrolled in high-deductible, consumer-directed plans, the findings indicate that people in traditional plans also could face fairly large out-of-pocket costs.


"Financial Risk for COVID-19-like Respiratory Hospitalizations in Consumer-Directed Health Plans" was written by Matthew Eisenberg, Colleen Barry, Cameron Schilling, and Alene Kennedy-Hendricks.

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