Congress passed the Families First Coronavirus Response Act (FFCRA), requiring nearly all private health insurance plans cover any testing for COVID-19 with NO cost-sharing during the emergency period (meaning no co-pays or deductibles). But what happens if you are hospitalized for COVID-19? How much will that cost?
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How Much Do Hospitals Charge to Treat COVID-19?
“A consumer’s costs can be nearly impossible to predict exactly ahead of time, mainly because you won’t know what the hospital bill will be so you can’t calculate your share of it,” said Deb Gordon, former Chief Marketing Officer of a health plan in Massachusetts and author of The Health Care Consumer’s Manifesto. With that in mind, and realizing that there’s no historical price data for COVID-19, let’s use what data we have.
A recent study done by the Kaiser Family Foundation tried to sort out what patients might expect. They used pneumonia as a proxy for COVID-19 and assumed patients had health insurance through their employer. For a patient who did not have complications, Kaiser estimates the hospital bill would amount to a little less than $10,000. But that includes “the total costs for admissions, including both the amount paid by insurance and the amount paid out-of-pocket,” reads the study. In other words, the total cost of treatment is $10,000; patients aren’t on the hook for the entire amount. What a patient ends up paying is dependent on their particular insurance.
For those with complications or comorbidity, Kasier estimates hospital bills closer to $14,000. And for patients with major complications or comorbidity, the total bill could be over $20,000.
Treatment gets more expensive if you require a ventilator.
That same study found that treatment costs for people with respiratory conditions with or without major complications or comorbidity was, on average, $12,692 (again, this includes the amount both the insurance company paid and the out-of-pocket expenses for the patient). Those with respiratory system diagnosis with ventilator support for less than 96 hours can expect their total treatment costs to soar to $34,000. And those with respiratory system diagnosis with ventilator support for 96 hours or more will have treatment costs of $88,000.
Those are all average numbers based on pneumonia–what about a hospital stay in the epicenter of the pandemic? “Based on bills submitted by real New Yorkers, the average cost for a two-night hospital stay in Manhattan during 2019 was approximately $31,700 without insurance. With negotiated insurance rates, the average price was approximately $13,100, which is before the charges run through your insurance plan,” said Sarah Michalczuk Founder & CEO of predictaBill. That’s not too far off the $10,000 charge from the Kaiser study. But with insurance, that’s not the amount you’ll end up paying.
“You would then need to look at whether or not you’d owe a copay, how much your deductible is, and whether you’d owe a percentage of the charges after hitting your deductible (this is called coinsurance). This also does not include anything a surgeon or other doctor in the hospital might charge for their services,” Michalczuk added.
How Much of That Will I Pay?
This depends entirely on your health insurance plan. Check this listing of what many insurance plans are doing for COVID-19 to ease the cost burden. Some insurers are waiving copays, coinsurance, and deductibles for COVID-19. For example, “UnitedHealthcare is waiving costs for COVID-19 testing provided at approved locations in accordance with the CDC guidelines, as well as waiving copays, coinsurance and deductibles for visits associated with COVID-19 testing, whether the care is received in a physician’s office, an urgent care center or an emergency department. This coverage applies to Medicare Advantage and Medicaid members as well as commercial members,” reads the AHIP website
And while our health system makes it practically impossible to determine costs ahead of time, there are ways to estimate. Gordon recommends people look at their plans, especially their deductibles. Unless you’ve had a major medical issue already this year, it’s unlikely you’ve met that amount.
“My advice is for people to look at their plan documents or call the health plan to understand the specific amounts they have to pay for different kinds of services, and the specific rules that apply. For example, if you have a $1,000 or $2,000 deductible (the average is in between according to Kaiser Family Foundation), you can consider that the floor. You’re very likely to have a hospital bill larger than that, which means you’ll pay the $2,000 before insurance kicks in,” Gordon said.
“According to the Kaiser Family Foundation, 80% of individuals on employer-sponsored health insurance plans are responsible for $6,000 or less for in-network care in a worst-case scenario (your out-of-pocket limit). 38% are capped at $3,000 (or less),” Michalczuk said. But on the higher end, a study from HealthPocket found that in 2019, the average individual deductible for Standard Bronze Plans was $5,861, while the average deductible for those on a family plan was $12,186. As plans get better, costs generally go down.
“For the ceiling, look at the out-of-pocket maximum–the most you should have to pay in out-of-pocket costs in a health plan year. You theoretically reach the maximum when you’ve paid that amount in some combination of copayments, payments towards the deductible, or coinsurance. Typically, once you’ve hit the maximum, you shouldn’t have to pay any more out-of-pocket other than your premium. There are exceptions and loopholes, so not every cost you incur will be counted toward the maximum, such as if you go to an out-of-network doctor or hospital. But the maximum should be close to the most you’d have to pay,” said Gordon.
But there’s another caveat–in-network versus out-of-network hospitals. If you can, try and make sure that you end up at an in-network hospital (which we get is a hard thing to think about when you are gravely ill and in need of medical attention). “There is no cap on charges if you go to a hospital that is not in-network with your insurance plan, so as a precaution, it would be wise to locate the closest hospital that is in-network with your insurance plan now before you begin to feel ill. If you have specific questions about how your insurance plan works, predictaBill can help with that,” Michalczuk said.
What Part of My Hospital Bill Is My Responsibility?
When the bill arrives from your insurance company, it should show you the amount the hospital initially charged the hospital, the amount the insurance company negotiated the price down, and the remainder that you are left to pay. You might owe money to your insurance company, the hospital, or both.
If you are on employer-sponsored healthcare, you likely pay monthly premiums. “Beyond the monthly premium you pay for insurance coverage, the basic cost components consumers pay–what insurers call “cost sharing”–include copayments, coinsurance, and deductibles,” said Gordon. Here’s where you’ll start seeing the costs billed to you.
“Copayments don’t always apply to hospital stay, but could, and could apply to elements of your clinical experience. For example, if you first visit an emergency room and get sent home, you probably will be billed the copayment amount,” said Gordon. My previous insurance had a $200 copayment (copay) for any hospital visit. This information is typically written on the insurance card (alongside the copayment for a regular doctor’s visit and for prescription drugs, though you might have a separate card for prescriptions).
Gordon helped breakdown the costs a patient could pay using the costs from the Kaiser report–the one with a short hospital stay and no ventilator needed that was still almost $10,000. “If you have a $2,000 deductible and 20% coinsurance, in the Kaiser scenario, you would pay $4,000. You would have satisfied your deductible after the first $2,000, but you still need to pay the balance of the coinsurance amount,” Gordon said.
I’ve Gotten My Bill. Should I Pay It?
Once you get your bill, whether it is from insurance or directly from the hospital, get more details. “Do not ignore that bill. The first thing to do is ask for itemized detail for every charge,” said Gordon. Medical billing can be complex, but you might spot charges for a date you weren’t there or for a procedure you didn’t have. Medical billing mistakes happen all the time–in fact, it’s estimated that almost 80% of medical bills include errors.
Michalczuk encourages those with jobs to first check with their employer to see if the company has made contributions to a health savings account (HSA) or a health reimbursement account (HRA). And even if you’ve lost your job but had a HSA because you were on a high deductible health plan, you can use that pre-tax money to pay down your medical bills. Learn more about how HSA health plans work here.
Lively HSA is a great place to begin looking into an HSA. Lively allows you to save or invest with your HSA and there’s no cost to open an account or any monthly fees. See how Lively compares to competitors in our list of Best HSA Accounts.
What If My Plan Doesn’t Cover COVID-19 (Or All of It)?
Out-of-pocket expenses can limit access for patients who need care.
As mentioned before, back in March, Congress passed the Families First Coronavirus Response Act (FFCRA), which requires that nearly all private health insurance plans cover any testing for COVID-19 with NO cost-sharing during the emergency period (meaning no co-pays or deductibles).
We’ve already seen some states mandate similar COVID-19 coverage requirements for the health insurance providers that they regulate, while several private health insurance providers are voluntarily expanding coverage for COVID-19 testing.
The law that Congress passed mandates that any group health plan, as well as individual health insurance coverage, has to cover COVID-19 testing as well as any related visits if diagnosed during the emergency period. There are some exceptions to this, however, particularly with some forms of private coverage sold to individuals in the past.
Where things get a little more complex is with treatment. Many health plans are likely to cover much of the items and services needed to treat COVID-19, however, there’s not currently a federal mandate to do that.
Under the Affordable Care Act, the Essential Health Benefits benchmark outlines certain groups of services that are covered. Individual states, however, are supposed to benchmark their own policies that outline services that are covered for COVID-19.
Because of this, things like telemedicine, home care, or other much-needed services to treat COVID-19 may or may not be covered, and could vary widely when they are.
What If I Don’t Have Health Insurance?
If you had health insurance before the pandemic and lost your job, COVID-19 can feel like a double whammy. “Record unemployment now also increases the uninsured rate, and leaves people exposed to potentially ruinous health care bills just when they’re more at risk of getting sick and less able to absorb new expenses,” said Gordon.
If you’ve lost your job, you can go to healthcare.gov and sign up on the exchange (losing a job is considered a “triggering event,” allowing you to purchase healthcare outside of the open enrollment period). Most of the state-run exchanges have opened back up (some are open as far out as June), making it easier to qualify for health insurance. And Michalczuk says to enter in your new income when filling out the forms–that can help lower the costs of insurance and possibly open you up to assistance.
But if you can’t get coverage, a study by FAIR Health estimates that an average inpatient treatment for COVID-19 could run upwards of $75,000.
A study from April estimated that 2%– 7% of uninsured people would require hospitalization for COVID. That equals 670,000 to 2 million people. And that estimate was made before 26 million Americans filed for unemployment benefits.
Just as people with insurance need to ask for an itemized bill, so should the uninsured. That might help cut down costs. Then, Gordon says to talk with the hospital. Explain your situation and ask:
- What can the hospital do to lower your costs? Some hospitals have financial programs to help COVID-19 patients.
- What programs the hospital knows of that could help you pay.
After you’ve exhausted the hospital’s resources, look at local or national charities.
Some states are taking action in other ways, too. For example, a handful of states have changed rules about prescription medicine refills and future vaccines in order to help people ensure they have what they need ahead of time instead of waiting until the last minute.
In addition, states like New York, Oregon, and several others are requiring insurance providers in the state to waive any costs related to a COVID-19 vaccine if and when one becomes available.
What If I Can’t Afford It?
If you’ve gotten an itemized list of all the expenses (and verified that it looks correct–you can google medical codes online to better understand them) and talked to your hospital about lowering costs but find yourself with a bill you can’t afford, there are still some steps you can take.
Since this is an unprecedented event in modern history, our recommendations fall a bit outside our normal advice.
- Demand generosity from your insurer. Gordon says insurance companies are faring well during the pandemic. Hospitals have shuttered non-COVID-19 wards and with fewer demands on non-essential medical procedures, insurance companies find themselves paying out less money. “Consumers should also demand generosity from their health insurer. Many have stepped up to waive consumer costs for COVID-19 treatment. I applaud those who have. Others should follow, and might if they feel enough public pressure,” Gordon said.
- Make 100% sure there are no medical loopholes you’re missing. For example, Florida was the first state to get Medicaid flexibility for coronavirus treatment. It’s always best to call your physician as well as your health insurance provider and ask as many questions as you can to get clarity.
- Ask to set up a payment plan. Hospitals will often work with patients to set up manageable monthly payments, often without interest.
- Go Public. There’s no shortage of outrageous medical bills in the media, but a little public pressure can help. (This was also a tip for lowering your cable, internet, and phone bills during the pandemic in another Dough Roller story).
- Seek charity options. Some hospitals have received grants to help deal with the crisis and help those who do not have the means to pay for testing or treatment. Check with your hospital to see what programs are available.
- Set up a go-fund me account. It’s a long shot, but worth the try.
- Get smart with a credit card. In most cases, I would never recommend you use a credit card to pay for emergency medical expenses–this should always come from an emergency fund. But, in these challenging times, you can look at a card that offers 0% interest on purchases for an extended time period. For example, Chase Freedom gives you a full 15 months at 0% APR for both purchases and balance transfers (in case you need to transfer a medical bill over).
- Get a personal loan. This should only be considered if you have no other options. And if a credit card doesn’t work for you, you can always look at getting a larger personal loan. One of my favorites right now is SoFi, but you can check out our list of the best personal loan options as well.
The costs of contracting COVID-19 can vary greatly depending on your health, your health insurance, and the steps your state has taken to reduce the financial burden on individuals.
“It’s understandable for people to worry about health care costs, but in this pandemic, people really need to worry first about their health. If you need care, don’t avoid it because you’re worried about costs. We are in an unprecedented situation, and I believe there will be a groundswell of support to help people who can’t afford treatment,” Gordon said.