Some Insurers Waive Patients' Share Of Costs For COVID-19 Treatment

By Selena Simmons-Duffin

Published March 30, 2020 at 6:36 PM EDT

Aetna was the first insurer to announce its plan to help shield patients with COVID-19 from high medical bills. But out-of-network charges and other surprise bills remain a risk, say advocates for patients.

Three major health insurance providers have now pledged to shield patients from high medical bills if they need treatment for COVID-19. Insurers Cigna and Humana announced Monday that they would waive consumer costs associated with COVID-19 treatment. Last week, CVS Health announced a more limited change — that Aetna would waive costs to patients for hospital admissions related to the coronavirus.

These announcements are a "big deal" says Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University. She notes that, on average, people's deductibles for health policies in the U.S. run between $1,800 and $6,500. "That's — for most families — a lot more cash than they have sitting in their bank account," she says. "So that's really scary."

All three insurers have now pledged to waive the patient's portion of a medical bill — what's called a patient's " cost sharing." That means, if your plan qualifies, you won't have to pay your full deductible before insurance will take over, or have to pay the usual fixed amount for a medical service or treatment (the copayment), or a percentage of the total bill ( coinsurance).

These insurers have also pledged to waive costs to patients for coronavirus testing and telemedicine visits related to COVID-19 and its symptoms.

So far, Aetna and Cigna are pledging to waive COVID-19 treatment costs through qualified medical bills that are incurred until June 1, 2020. Humana's policy does not yet have an end date.

In the scheme of things, says Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation, this move won't cost insurers much, since patient co-pays and deductibles usually account for only a fraction of expensive hospital stays.

"I think there's also a political element here," he says. "Insurers are likely going to be asking Congress for some kind of bailout, and they want to look like good community players when they make that ask."

Still, not every patient will be spared high medical bills if they get seriously ill with COVID-19. You have to have insurance — 28 million people in the U.S. do not — and, for now, your insurance provider needs to be one of these three companies, though others may follow their lead.

Levitt also notes that many people who are covered by an insurance company that has made a commitment like this might not be eligible to have their costs waived. "Most of the people who get insurance through employers are in what are called self-funded plans," he explains. For people in those plans, these announcements don't apply, since "it's the employers who are going to be deciding whether patients get cost relief here or not."

Levitt also warns that patients who can't get a test for the coronavirus, or whose test comes back as a false negative might still be on the hook for out-of-pocket costs. Until testing becomes more widely and readily available, he says, that hitch could be a substantial problem for patients hoping to have their medical bills covered.

There's also the issue of surprise bills. Even if you don't have to pay your health insurer, you could still be billed directly by the hospitals or doctors who provide your care if they are out of your insurance network. Nearly 1 in 5 inpatient admissions for pneumonia results in a surprise bill, according to a Kaiser Family Foundation analysis.

Loren Adler, associate director of USC-Brookings Schaeffer Initiative for Health Policy, says he's hopeful that Congress will act to protect patients from surprise bills in these situations, or that providers will refrain from balance billing, given the nature of the crisis.

"There is a very strong incentive on basically all actors not to let surprise bills happen here — much stronger than in normal cases," Adler says. "I am hopeful folks will negotiate this without involving the patient, but the possibility is still there."

Overall, the insurer announcements on waiving patient cost sharing are good news, but there are caveats, and those caveats mean many people may still have to worry about their medical bills in the midst of this epidemic, says Levitt.

"On any normal day, the expense of a hospitalization for a patient — even someone with insurance — can be overwhelming," he says. "But now we're looking at these health care expenses coming on top of uncertainty about the economic future, people losing their jobs or getting their hours reduced — it's a perfect storm."