Americans will most likely pay significantly more for COVID medical care during this new wave of cases — whether that is a routine coronavirus test or a lengthy hospitalization.
Earlier in the pandemic, most major health insurers voluntarily waived costs associated with a COVID treatment. Patients did not have to pay their normal copayments or deductibles for emergency room visits or hospital stays.
Most COVID tests were free, too.
The landscape has since changed, as the pandemic persists into its second year. Federal law still requires insurers to cover testing at no cost to the patient when there is a medical reason for seeking care, such as exposure to the disease or a display of symptoms. But more of the tests sought now do not meet the definition of “medical reason” and are instead for monitoring.
And insurers are now treating COVID more like any other disease, no longer fully covering the costs of care. Some businesses, like Delta Air Lines, are planning to charge unvaccinated employees higher rates for insurance, citing in part the high hospitalization costs for COVID cases.
“Insurers are confronting the question about whether the costs of COVID treatment should fall on everyone, or just the individuals who have chosen not to get a vaccine,” said Cynthia Cox, a vice president at the Kaiser Family Foundation who has researched how insurers are covering COVID treatment.
The federal rules that make coronavirus testing free include exemptions for routine workplace and school testing, which has become more common as students head back to the classroom and as companies mandate regular testing for unvaccinated workers.
Because insurers are not required to cover that regular testing, some patients have already received testing bills as high as $200 for routine screenings, according to documents that patients have submitted to a New York Times project tracking the costs of COVID testing and treatment.
Some of the highest bills, however, will probably involve COVID patients who need extensive hospital care now that most insurers no longer fully cover those bills. Seventy-two percent of large health plans are no longer making COVID treatment free for patients, a recent study from the Kaiser Family Foundation found.
This includes Blue Cross Blue Shield of Florida, the largest health plan in a state experiencing one of the country’s worst outbreaks. On Wednesday, Florida Blue began requiring patients to pay their normal deductibles and copayments for COVID treatment. Toni Woods, a spokeswoman, said the plan was now focused on encouraging vaccinations.
“When the COVID-19 pandemic began last year, we implemented several emergency provisions to temporarily help our members,” she said in a statement. “Medical diagnostic testing for COVID-19 as well as vaccinations continue to be available to members at $0 cost share.”
Oscar Health, which sells coverage in Florida and 14 other states, also ended free COVID treatment this week. It cited the widespread availability of the vaccine as a key reason.
“We started waiving cost sharing for COVID-19 treatment at the peak of the pandemic in 2020, when there were few options available for those who fell ill with the virus,” said Jackie Khan, an Oscar spokeswoman. “We believe that the COVID vaccine is our best way to beat this pandemic, and we are committed to covering it and testing at $0 for our members.”
The new policies generally apply to all patients, including the vaccinated; people who get sick with a breakthrough infection; and children under 12, who are not yet eligible for the vaccine.
“If you have a small kid who gets COVID at school and ends up at the ICU, that family is going to now be stuck with the bill even though that patient did not have the ability to get vaccinated,” said Dr. Kao-Ping Chua, a pediatrician at the University of Michigan who researches COVID care costs.
The average COVID hospitalization costs approximately $40,000, researchers have found. A lengthy hospital stay — one that requires time in the intensive care unit, or a transfer by air ambulance — can cost many multiples more. Most insured patients will not pay that entire bill. They will face whatever share they owe through deductibles and copayments.
Chua and his colleagues published research this summer finding that, among patients who had to pay a share of their COVID hospitalization, the average costs were $3,800.
“There were some patients where it was $10,000 and others where it was $500,” he said. “It gives you some semblance of what things will now look like without the waivers.”
Surprise bills for routine COVID testing could be smaller but more common, as schools and workplaces increasingly rely on regular screening to prevent coronavirus from spreading.
At many workplaces, unvaccinated workers must submit to monitoring at least weekly. Some employers, including the federal government, plan to fully cover the costs of those tests. But others, including some hotels and universities, will ask unvaccinated workers to bear some or all of the testing costs.
Rebecca Riley recently received a $200 bill from a laboratory with an unfamiliar name. When she called to inquire about the charge, she learned it was a fee for a COVID test. Her son, a high school student, is regularly tested at his Los Angeles-area high school.
“I didn’t expect to get any bills,” she said. “I feel stupid, but I’d heard the tests were free.”
Riley contacted her insurer about the charge and it agreed to pay the full amount. But she now worries about future surprise testing bills.
“I really feel for the families that won’t be able to pay,” she said.