Health plans phasing out cost-sharing waivers for COVID treatment
As vaccines have become more widely available, health insurers are less willing to cover the cost of avoidable health care treatment.
Nearly three-fourths of the nation’s largest health plans no longer waive cost-sharing for COVID-19 treatment, the Peterson-KFF Health System Tracker reported.
Federal law requires all private insurance plans to cover the entire cost associated with approved COVID-19 testing as long as the test is deemed medically appropriate. Additionally, the U.S. government prepaid for COVID-19 vaccines and required them to be made available at no out-of-pocket expense, regardless of whether the vaccine recipient is insured. However, although a handful of states required or created agreements with insurers to waive COVID-19 out-of-pocket treatment costs for their fully insured plan enrollees, there is no federal mandate requiring insurers to do so.
Related: Insurers pull the plug on telehealth cost-sharing waivers
In the last few months, the environment has shifted, with safe and highly effective vaccines now widely available. According to the latest statistics:
- 72% of the two largest insurers in each state and the District of Columbia no longer waive these costs, and another 10% of plans are phasing out waivers by the end of October.
- Almost half of these plans ended cost-sharing waivers by April 2021, which is around the time most states were opening vaccinations to all adults.
- Of the 29 plans still waiving cost-sharing for COVID-19 treatment, 10 waivers are set to expire by the end of October.
- Another 12 plans said their cost-sharing waivers will expire by the end of 2021.
- Two plans specified end dates for COVID-19 treatment waivers in 2022, and five plans did not specify an expiration date.
“Earlier in the pandemic, relatively few COVID-19 patients would have been billed for their hospitalization because of the voluntary waivers extended by private insurers and employers,” the report concluded. “But as vaccines have become widely available to adults in the United States, and health care utilization has rebounded more generally, health insurers may no longer face political or public relations pressure to continue waiving costs for COVID-19 treatment. As more waivers expire, more people hospitalized for COVID-19 — the vast majority of whom are unvaccinated — will likely receive significant medical bills for their treatment.”
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