Assessment of Out-of-Pocket Spending for COVID-19 Hospitalizations in the US in 2020
Authors: Kao-Ping Chua, Rena M. Conti, Nora V. Becker
Journal: JAMA Network Open (2021)

<h3>Importance</h3> Many 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. Assessment of out-of-pocket spending for COVID-19 hospitalizations in 2020 may show the financial burden that patients may experience if insurers allow waivers to expire, as many chose to do during 2021. <h3>Objective</h3> To estimate out-of-pocket spending for COVID-19 hospitalizations in the US in 2020. <h3>Design, Setting, and Participants</h3> This cross-sectional study used data from the IQVIA PharMetrics Plus for Academics Database, a national claims database representing 7.7 million privately insured patients and 1.0 million Medicare Advantage patients, regarding COVID-19 hospitalizations for privately insured and Medicare Advantage patients from March to September 2020. <h3>Main Outcomes and Measures</h3> Mean total out-of-pocket spending, defined as the sum of out-of-pocket spending for facility services billed by hospitals (eg, accommodation charges) and professional and ancillary services billed by clinicians and ancillary providers (eg, clinician inpatient evaluation and management, ambulance transport). <h3>Results</h3> Analyses included 4075 hospitalizations; 2091 (51.3%) were for male patients, and the mean (SD) age of patients was 66.8 (14.8) years. Of these hospitalizations, 1377 (33.8%) were for privately insured patients. Out-of-pocket spending for facility services, professional and ancillary services, or both was reported for 981 of 1377 hospitalizations for privately insured patients (71.2%) and 1324 of 2968 hospitalizations for Medicare Advantage patients (49.1%). Among these hospitalizations, mean (SD) total out-of-pocket spending was $788 ($1411) for privately insured patients and $277 ($363) for Medicare Advantage patients. In contrast, out-of-pocket spending for facility services was reported for 63 hospitalizations for privately insured patients (4.6%) and 36 hospitalizations for Medicare Advantage patients (1.3%). Among these hospitalizations, mean (SD) total out-of-pocket spending was $3840 ($3186) for privately insured patients and $1536 ($1402) for Medicare Advantage patients. Total out-of-pocket spending exceeded $4000 for 2.5% of privately insured hospitalizations compared with 0.2% of Medicare Advantage hospitalizations. <h3>Conclusions and Relevance</h3> In this cross-sectional study, few patients hospitalized for COVID-19 in 2020 were billed for facility services provided by hospitals, suggesting that most were covered by insurers with cost-sharing waivers. However, many patients were billed for professional and ancillary services, suggesting that insurer cost-sharing waivers may not have covered all hospitalization-related care. High cost sharing for patients who were billed by facility services suggests that out-of-pocket spending may be substantial for patients whose insurers have allowed waivers to expire.