During 2020, many hospitalized COVID-19 patients were hit with hundreds of dollars of out-of-pocket costs even when there were cost-sharing waivers, a new study shows.

An analysis of data from 4,075 U.S. hospitalizations revealed that privately insured patients incurred an average out-of-pocket cost of $788, while those covered by Medicare Advantage incurred an average out-of-pocket cost of $277.

Out-of-pocket spending for hospitalizations that did not have a cost-sharing waiver was $3,840 for the privately insured and $1,536 for those with Medicare Advantage, researchers report in JAMA Network Open.

“The main take-home message is that patients hospitalized for COVID-19 going forward are likely to face substantial bills, specifically, those who are privately insured and whose plans no longer waive bills are estimated to pay $3,800 out of pocket,” said the study’s first author, Dr. Kao-Ping Chua of the University of Michigan Medical School, in Ann Arbor. “A major driver of out-of-pocket costs is facility services, that is, room and board costs.”

“A really important point is that some say that since the vaccines are widely available, it’s justified to start charging for COVID-19 hospitalizations because only the unvaccinated will be charged,” Dr. Chua said. “This implies that the only people being billed (for these high out-of-pocket costs) are those who are unvaccinated. But young children are ineligible to be vaccinated, as are the immune compromised who despite being vaccinated can be infected.”

“My major worry with this policy is that patients who have severe COVID symptoms may put off going to the hospital because they are worried about costs,” Dr. Chua said. “And ultimately this could increase the likelihood of complications and the possibility of death.”

To take a closer look at out-of-pocket costs COVID-19 patients incurred when hospitalized, Dr. Chua and his colleagues conducted a cross-sectional analysis of the IQVIA PharMetrics Plus for Academics database, which contains fully adjudicated medical and pharmacy claims from deidentified patients in the 50 states plus the District of Columbia, in May 2021. At the time of analysis, the claims were complete through September 30, 2020.

Included in the database were 1 million patients covered by Medicare Advantage Plans and 7.7 million patients covered by private plans in 2020, all of which were fully insured plans. The data comes from a fixed group of plans whose identities are confidential.

The analysis included hospitalizations between March 1 and September 29 that had a confirmed primary diagnosis of COVID-19, amounting to 4,075 hospitalizations among 3,875 unique patients. Among those hospitalized, the mean age was 67 years and 51 percent were male. Thirty-four percent were for privately insured patients.

Out-of-pocket spending for facility services, professional and ancillary services or both was reported for 981 of 1377 (71 percent) hospitalizations for privately insured patients and 1,324 of 2,968 (49 percent) hospitalizations for Medicare Advantage patients.

“As the study found, despite cost-sharing waivers, COVID-19 hospitalization incurs cost-sharing for many patients,” said Ge Bai, a professor of accounting at the Johns Hopkins Carey Business School and a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

“Tradeoffs exist between ending versus extending cost-sharing waivers,” Dr. Bai, who was not involved in the study, told Reuters Health by email. “If cost-sharing waivers are ended, COVID-19 patients face substantial financial burden for hospitalization, but the pressure on raising premiums for all beneficiaries is contained and the daunting cost for hospitalization might reduce vaccination hesitancy.”

“On the other hand, if cost-sharing waivers are extended, COVID-19 patients are protected from high cost exposure, their COVID-19 treatment costs will be spread out among all beneficiaries though higher premiums, and financial considerations will not serve as a deterrent to vaccine-hesitant population unless they are excluded from the waiver extension,” Bai said.