Out-of-Pocket Spending for COVID-19 Hospitalizations in 2020
Authors: Chua Kao-Ping , Conti Rena M. , Becker Nora V. 
Published: May 2021

ABSTRACTIMPORTANCEMany insurers waived cost-sharing for COVID-19 hospitalizations during 2020. Nonetheless, patients may have been billed if their plans did not implement waivers or if waivers did not capture all hospitalization-related care, including clinician services. Assessing out-of-pocket spending for COVID-19 hospitalizations in 2020 could demonstrate the financial burden patients may face if insurers allow waivers to expire, as many chose to do during early 2021.OBJECTIVETo estimate out-of-pocket spending for COVID-19 hospitalizations in 2020DESIGNCross-sectional analysisSETTINGIQVIA PharMetrics® Plus for Academics Database, a national claims databasePARTICIPANTSCOVID-19 hospitalizations for privately insured and Medicare Advantage patients during March-September 2020MAIN OUTCOMES/MEASURESMean total out-of-pocket spending, defined as the sum of out-of-pocket spending for facility services billed by hospitals (e.g., accommodation charges) and for professional/ancillary services billed by clinicians and ancillary providers (e.g., clinician inpatient evaluation and management, ambulance transport)RESULTSAnalyses included 4,075 hospitalizations. Of the 1,377 hospitalizations for privately insured patients and the 2,698 hospitalizations for Medicare Advantage patients, 981 (71.2%) and 1,324 (49.1%) had out-of-pocket spending for facility services, professional/ancillary services, or both. Among these hospitalizations, mean (SD) total out-of-pocket spending was $788 (1,411) and $277 (363). In contrast, 63 (4.6%) and 36 (1.3%) hospitalizations had out-of-pocket spending for facility services. Among these hospitalizations, mean total out-of-pocket spending was $3,840 (3,186) and $1,536 (1,402). Total out-of-pocket spending exceeded $4,000 for 2.5% of privately insured hospitalizations, compared with 0.2% of Medicare Advantage hospitalizations.CONCLUSIONSFew COVID-19 hospitalizations in this study had out-of-pocket spending for facility services, suggesting most were covered by insurers with cost-sharing waivers. However, many hospitalizations had out-of-pocket spending for professional/ancillary services. Overall, 7 in 10 privately insured hospitalizations and half of Medicare Advantage hospitalizations had any out-of-pocket spending. Findings suggest insurer cost-sharing waivers may not cover all hospitalization-related care. Moreover, high cost-sharing for some hospitalizations suggests out-of-pocket burden could be substantial if waivers expire, particularly for privately insured patients. Rather than rely on voluntary insurer actions to mitigate this burden, federal policymakers should consider mandating insurers to waive cost-sharing for all COVID-19 hospitalization-related care throughout the pandemic.KEY POINTSQuestionHow much were patients billed for COVID-19 hospitalizations in 2020?FindingsOf 1,377 and 2,698 COVID-19 hospitalizations for privately insured and Medicare Advantage patients, 71.2% and 49.1% had cost-sharing for facility services billed by hospitals, services billed by clinicians or ancillary providers, or both. Among these hospitalizations, mean out-of-pocket spending was $788 and $277. 4.6% and 1.3% had cost-sharing for facility services; among these hospitalizations, mean out-of-pocket spending was $3,840 and $1,536.MeaningInsurer cost-sharing waivers for COVID-19 hospitalizations may not cover all hospitalization-related care. Patient out-of-pocket burden could be substantial if insurers allow waivers to expire.