Aug. 28, 2020
Nine in 10 Americans enrolled in private insurance are in plans that waived out-of-pocket costs for COVID-19 treatment at some point during the pandemic. Federal law requires private insurers to waive cost sharing for COVID-19 testing and testing-related office visits (in-person or telehealth), urgent care visits and emergency room visits, but does not speak to cost sharing for treatment. According to a recent analysis by the Peterson Center on Healthcare and the Kaiser Family Foundation (KFF), many of these plan-specific waivers have or will expire at the end of September, leaving just over half of all private plan enrollees with protection from out-of-pocket costs for COVID-19 treatment.
Out-of-pocket costs for individuals with employer-sponsored coverage are, on average, at least $1,300 for COVID-19-related inpatient hospital treatment.
Across all individual and fully insured group plans, the Peterson-KFF analysis found that:
- 88% of enrollees’ plans waived out-of-pocket costs for COVID-19 treatment at some point during the pandemic;
- 20% of enrollees in these markets are in plans with an expired waiver; and
- 16% of enrollees are in plans with a waiver set to expire by the end of September.
Among enrollees in individual and fully insured group markets, one in three are in plans that have waived cost sharing for COVID-19 treatment for the rest of the year. Another 15% of those enrollees are in plans with an unspecified waiver expiration date or a waiver that remains effective until the end of the pandemic. The Peterson-KFF analysis notes that most waivers apply only to COVID-19 treatment from in-network providers. Patients treated out of network may have to pay the entire cost of COVID-19 treatment.
The analysis is based on a summary of responses from private insurers compiled by America’s Health Insurance Plan, which was combined with enrollment data from Mark Farrah Associates TM.