Early last month President Trump announced that tests for COVID-19 infection would be included in the ten Essential Health Benefits (EHB) specified in the Affordable Care Act (ACA).
NOW, two major health insurers HUMANA and CIGNA have come forward with an ADDITIONAL commitment to waive out-of-pocket costs for the treatment of patients infected by COVID-19.
We will discuss more about Coronavirus Treatment cost waived off by Humana and Cigna, but before let’s let’s look at how much it costs to treat COVID-19.
Coronavirus treatment cost
It is too soon for anything but educated guesses. These suggest that the cost of COVID-19 hospitalization and treatment could average over $20,000 per person. For most citizens with health insurance, either individual or group (employer), the average out-of-pocket expense would be $1,300.
The US Centers for Disease Control and Prevention (CDC) projection is for between 2.4 and 21 million citizens to need hospitalization and that a significant proportion of these will need intensive care, e.g. respiratory therapy.
Actual costs will depend on severity and any chronic or underlying conditions. There are anecdotal reports of charges exceeding $34,000.
It is clear that the US, in common with most other countries worldwide, faces a massive threat from COVID-19. This is an easily spread ‘flu-like disease for which there is, as yet, no known cure. The World Health Organization (WHO) estimates that 80% of those infected will recover without needing special treatment (see the article on self-isolation during Coronavirus pandemic).
Does Medicare insurance cover Coronavirus?
Those most at risk are ‘seniors’ and individuals with chronic or underlying pulmonary conditions. With the benefit of Medicare and Medicaid, these are the groups most likely to be covered by health insurance. Both Medicare and Medicaid are bound by the terms of the ‘Families First Coronavirus Response Act’. This act passed by Congress (3/16/20) requires most private health plans to cover coronavirus testing with no cost-sharing.
Medicare and Medicaid have stepped beyond the terms of the act to include COVID-19 treatment with no cost-sharing. They have been joined by Humana and Cigna. It is likely that other health insurers such as Anthem and Aetna will follow suit; there is, however, no federal obligation to do so.
At a time when it is important to slow the spread of the disease, it is critical to maintain ‘social distancing’ and to facilitate testing and treatment. The actions of these organizations remove the main factor (finance) which deters even insured individuals from accessing tests and treatment.
Read more about: Does Medicare plans cover Coronavirus tests and treatments
There is a general agreement that the practice of ‘balance billing’ (see our article) should be reviewed. IN PARTICULAR Humana and Cigna have indicated that they would resolve issues that arise when service is delivered by an out-of-network provider, especially when the patient is not advised or is unable to make a decision. Humana CEO Bruce Broussard says “we will keep it [a surprise billing dispute] between the provider and the company” [the insurer].
Read our article on healthcare surprise billing
In a further move to: –
- Ease the pressure on medical offices
- Lessen the need to leave home (social distancing, see our article…)
the major players in the health insurance industry are encouraging the use of TELEMEDICINE and easing pre-authorization requirements.
There are, of course, some limitation
- Some large employers run their own (self-insurance)
schemes and may not offer the same EHB nor be bound by the terms of the FFCR act – most companies will adopt these new standards but all members of group schemes should check with their HR dept
- The private health insurers’ cost waivers are (currently) time gated, namely MAY 30th 2020 (or defined by some term such as ‘for the duration of the Coronavirus crisis)
- In all cases the actual terms of your plan will vary between insurance companies. You should check with your insurer
- IF you have a ‘short term’ plan it is unlikely to offer you the benefit of these changes. You should: –
- Check with your insurer
- Discuss your circumstances with a health insurance exchange to determine the best alternatives. You may, for example, qualify for a Special Enrolment Period
The Private Exchanges, such as TrueCoverage obviously regret the circumstances which necessitated these changes.
Clearly, these changes are intended to improve the operation of the market and the service provided to meet immediate, individual client and societal concerns. The changes may be expedient in the short term but, in the longer term it may prove difficult for the ‘healthcare industry’ to revert to a system which was already coming under criticism.
Much of the cost of these changes is being absorbed by the insurers and, less obviously, by service providers and the pharmaceutical companies.
We must wait to see but we should probably brace ourselves for a root and branch rebalancing of the prices we pay for each element of our healthcare.
The purpose of the ‘exchanges’ is to ensure that everyone has the opportunity to consider and compare insurance plans that best meet their needs.