Say goodbye to the exemptions of some insurers for COVID treatment fees


Just as other industries are reversing some consumer-friendly changes made in the early days of the pandemic (think there are gaps in airplanes), so are health insurers.

Many voluntarily waived all deductibles, copayments, and other costs for insured patients who became ill with covid-19 and needed hospital care, doctor visits, medications, or other treatments.

Leaving these quotas aside was a good step from a public relations standpoint. The industry obtained credit to help customers in difficult times. And it also had political and financial advantages for insurers.

But nothing lasts forever.

From the end of last year – and until the spring -, a growing number of insurers are quietly ending the exemptions from rates for covid treatment in some or all policies.

When it comes to treatment, there will be more and more consumers who will apply the normal course of franchises, co-payments and co-insurance, “said Sabrina Corlette, research professor and co-director of the University’s Center on Health Insurance Reforms. of Georgetown.

Still, “the good news is that vaccinations and most covetous testing should be free,” Corlette added.

This is because federal law requires insurers to waive the costs of coveted testing and vaccination.

Orientation published early in President Joe Biden’s term reinforced the Trump administration’s rule on waiving cost-sharing for testing and said it applies even in situations where an asymptomatic person wants to make a try before, for example, to visit a relative.

But the treatment is different.

Insurers voluntarily waived these costs, so they can decide when to reimburse them.

In fact, the initial step in not charging treatment fees may have prevented any effort by the federal government to demand a warrant, said Cynthia Cox, KFF vice president and director of its Care Act program. Accessible.

In a to study published in November, the researchers found that approximately 88% of people covered by insurance plans (those purchased by individuals and some group plans offered by employers) had policies that waived these payments at some point in the pandemic. , said Cox, co-author. But many of those resignations were expected to expire later this year or early this year.

Some do.

Anthem, for example, stopped them in late January. UnitedHealth, another of the country’s largest insurers, began withdrawing waivers in the fall, ending in late March. Dovert-free hospital treatment for covid using Aetna expired on 28 February.

Some insurers continue to waive patient cost sharing in some types of policies. human, for example, has dropped the cost-sharing waiver for Medicare Advantage members, but withdrew it on Jan. 1 for those with work-based group plans.

Not everyone makes the changes.

For example, First Blue Cross in Washington i Acute health plan in California they have extended treatment cost exemptions until June. Kaiser Permanente said it keeps its program in place for members diagnosed with covid and has not set an end date. In the meantime, UPMC in Pittsburgh he planned to continue waiving all copayments and deductibles for online treatment until April 20th.

That means

Waivers can result in little savings for people with mild cases of covidi being treated at home. But the savings for patients who fall seriously ill and end up in the hospital can be considerable.

Emergency room visits and hospitalization are expensive and many insured patients have to pay a portion of those costs through annual deductibles before starting full coverage.

Franchises have increased for years. Single-coverage deductibles for people working for large employers average $ 1,418, while those for small business workers average $ 2,295, according to a survey of employers for KFF. (KHN is an editorial program independent of KFF.)

The annual discounts on the Economic Care Act plans are generally higher, depending on the type of plan.

Both types of coverage also include copayments, which are fixed amounts, and often coinsurance, which is a percentage of the cost of office visits, hospital stays, and prescription drugs.

Ending treatment waivers “is a big deal if you get sick,” said Robert Laszewski, a consultant for the insurance industry in Maryland. “And then you find out you have to pay $ 5,000 out of pocket that your cousin didn’t pay two months ago.”

Costs and benefits

However, these patient quotas represent only a portion of the overall cost of care for a hospitalized patient with covid.

While it helped patients cash flow, insurers saw other types of benefits.

On the one hand, insurers initially acknowledged that patients, who faced home stay orders and other restrictions, were massively avoiding medical care, reducing what insurers had to strive for. get attention.

I think they were realizing that they would report extraordinarily good profits because they saw their use falling like a rock, “Laszewski said.” Doctors, hospitals, restaurants and everyone had big problems. So it was a good policy to give up copayments and deductibles. “

In addition to generating goodwill, insurers can benefit in another way.

According to the ACA, insurers must spend at least 80% of their primary income on direct health care, rather than marketing and administering it. (Large group plans must spend 85%.)

By waiving those fees, insurers ’spending rose slightly, which could help offset some of what is expected to be sharp rebates this summer. This is because insurers spending on direct health care does not reach the ACA threshold must issue bonuses on August 1 to people or employers who have purchased the plans.

A record $ 2.5 billion was broken by current policies in 2019, with an average discount per person reaching $ 219.

Knowing that their expenses were declining during the pandemic helped them make decisions to waive patients ’copayments for treatment, as insurers knew they“ would have to return that money one way or another because of the bonuses, ”he said. dir Cox.

It is a mixed bag for consumers.

“If they fully offset the bonuses by waiving the cost-sharing, it will only strictly benefit those with covid who need significant treatment,” Cox noted. “But if they issue rebates, there’s a wider distribution.”

Even with that, insurers can expect to return a lot in bonuses this fall.

In a report this week, KFF estimated that insurers could owe $ 2.1 billion in bonuses for last year’s policies, the second highest amount issued under the ACA. By law, bonus amounts are based on three years of financial data and benefits. No final numbers are expected until the end of the year.

The rebates “are probably motivated in part by the abolition of health care use during the COVID-19 pandemic, ”the report says.

Still, economist Joe Antos of the American Enterprise Institute says giving up copayments and deductibles can increase goodwill in the public eye rather than bonuses. “It’s an advantage for the community for which they could get credit,” Antos said, while many policyholders who receive a bonus check can only collect it and “it has no impact on how they think about anything.”

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