By Abigail Abrams
March 19, 2020
When Danni Askini started feeling chest pain, shortness of breath and a migraine all at once on a Saturday in late February, she called the oncologist who had been treating her lymphoma. Her doctor thought she might be reacting poorly to a new medication, so she sent Askini to a Boston-area emergency room. There, doctors told her it was likely pneumonia and sent her home.
Over the next several days, Askini saw her temperature spike and drop dangerously, and she developed a cough that gurgled because of all the liquid in her lungs. After two more trips to the ER that week, Askini was given a final test on the seventh day of her illness, and once doctors helped manage her flu and pneumonia symptoms, they again sent her home to recover. She waited another three days for a lab to process her test, and at last she had a diagnosis: COVID-19.
A few days later, Askini got the bills for her testing and treatment: $34,927.43. “I was pretty sticker-shocked,” she says. “I personally don’t know anybody who has that kind of money.”
Like 27 million other Americans, Askini was uninsured when she first entered the hospital. She and her husband had been planning to move to Washington, D.C. this month so she could take a new job, but she hadn’t started yet. Now that those plans are on hold, Askini applied for Medicaid and is hoping the program will retroactively cover her bills. If not, she’ll be on the hook.
She’ll be in good company. Public health experts predict that tens of thousands and possibly millions of people across the United States will likely need to be hospitalized for COVID-19 in the foreseeable future. And Congress has yet to address the problem. On March 18, it passed the Families First Coronavirus Response Act, which covers testing costs going forward, but it doesn’t do anything to address the cost of treatment.
While most people infected with COVID-19 will not need to be hospitalized and can recover at home, according to the World Health Organization, those who do need to go to the ICU can likely expect big bills, regardless of what insurance they have. As the U.S. government works on another stimulus package, future relief is likely to help ease some economic problems caused by the coronavirus pandemic, but gaps remain.
Because of our fragmented health care system, it depends on what kind of insurance you have, what your plan’s benefits are, and how much of your deductible you’ve already paid down.
A new analysis from the Kaiser Family Foundation estimates that the average cost of COVID-19 treatment for someone with employer insurance—and without complications—would be about $9,763. Someone whose treatment has complications may see bills about double that: $20,292. (The researchers came up with those numbers by examining average costs of hospital admissions for people with pneumonia.)
How much of that do I have to pay?
Most private health insurance plans are likely to cover most services needed to treat coronavirus complications, but that doesn’t include your deductible—the cost you pay out-of-pocket before your insurance kicks in. More than 80% of people with employer health insurance have deductibles, and last year, the average annual deductible for a single person in that category was $1,655. For individual plans, the costs are often higher. The average deductible for an individual bronze plan in 2019 was $5,861, according to Health Pocket.
In both complicated and uncomplicated cases, patients with employer-based insurance can expect out-of-pocket costs of more than $1,300, the Kaiser researchers found. The costs were similar regardless of complications because many people who are hospitalized reach their deductible and out-of-pocket maximum.
Many health insurance plans also require co-pays or co-insurance, too. Those costs are often 15-20% for an in-network doctor, meaning you would pay that portion of the cost, and can be much more for out-of-network doctors.
Medicare and Medicaid will also likely cover the services needed for coronavirus treatment, but the details on deductibles (for Medicare) and potential co-pays will again depend on your plan, and which state you’re in for Medicaid.
What if I’m uninsured?
It’s not pretty. Some hospitals offer charity care programs and some states are making moves to help residents pay for COVID-19 costs beyond testing. Several states, including Maryland, Massachusetts, Nevada, New York, Rhode Island and Washington, have created “special enrollment periods” to allow more people to sign up for insurance mid-year.
Other states are requiring coverage of future vaccines or changing rules about prescription medication refills to help people stock up on essential medicines. So far, Maine, Maryland, Massachusetts, Nevada, New Mexico, New York and Oregon have required insurers to waive costs for a COVID-19 vaccine once one is ready, and the states that have loosened rules to help people fill prescriptions include Alaska, Colorado, Delaware, Florida, Maine, Maryland, New Hampshire, North Carolina and Washington.
The Commonwealth Fund, a healthcare think tank, has a coronavirus tracker that’s keeping a list of the moves each state has made so far.
There’s no way I could afford to pay out-of-pocket for care. What can I do?
The U.S. health care system doesn’t have a good answer for you, and it’s a problem. But there are a few things to keep in mind that could help minimize costs.
If you think you may have the virus, the first step is to call your doctor or emergency department before showing up, the CDC says. This will let them prepare the office and give you instructions ahead of time, but it could also save you money. Getting treated in a hospital will generally start off more expensive than a visit to a doctor’s office. Another cost comes from the “facilities fee,” which many hospitals charge anytime a patient comes through their doors. For Danni Askini’s first trip to the hospital in Boston on Feb. 29, for example, she was charged $1,804 for her emergency room visit and another $3,841.07 for “hospital services.”
Other costs to watch out for include lab tests, which can be “out-of-network” even if the doctor treating you is in your insurance network. It’s always best to ask for information in writing so that you can appeal the bills if necessary, says Caitlin Donovan of the National Patient Advocate Foundation. And appealing is worth it. Often, providers and insurers have reversed or lowered bills when patients go public or are covered by the media.
These problems aren’t coming out of the blue. Even when we’re not weathering a global pandemic, Americans face uniquely high health care costs, compared to the rest of the world, and millions of us already put off medical care because of concerns about how much it’ll cost. But with COVID-19 sweeping across the country, an old problem becomes increasingly urgent: many Americans could still face massive treatment bills, or seek to prevent those by avoiding testing and treatment—worsening the outbreak further.