Covid-19 Care Isn't Affordable for All
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What is the main topic discussed in this episode?
Here's your money briefing for Tuesday, September 15th. I'm J.R. Whalen for The Wall Street Journal. We're six months into the pandemic, and for many people who've been afflicted with COVID-19, the hospital bill is coming due. The government and insurance companies have set up systems to avoid surprise medical bills. But some patients are falling through the cracks.
There are all kinds of problems because cost sharing has only been waived for this one illness. And it sort of speaks to this patchwork system of universal health care, but only for one illness.
So who actually foots the bill for COVID-19 treatments? Our reporter Robbie Whalen will explain after the break.
Hospital treatments for COVID-19 infections can cost up to hundreds of thousands of dollars. Insurance picks up a lot of that cost for many patients, but not all of them. And if Congress and insurers miss some upcoming funding deadlines, it could mean a hefty bill for patients. Our reporter Robbie Whalen joins us to explain. So first of all, Robbie, when the pandemic first hit, the government tried to make it easy for people afflicted with COVID-19 to get treatment but not get hit with a lot of surprise bills. But the results weren't that simple.
What government actions aimed to make COVID-19 testing and treatment free?
When the pandemic first hit, Congress authorized the CARES Act, which included a couple of provisions that are relevant here. One is that all testing ought to be free.
How do provider relief funds work and who uses them?
The other really relevant piece here is they authorized $175 billion in what are called provider relief funds. And those are funds that hospitals and other medical services providers can apply for for reimbursement for the cost of treatment. So there's two components, testing and treatment. And those funds were actually primarily used by people who are uninsured. So in theory, if you're an uninsured patient, you don't have health insurance, which is about 28 million Americans. and you get the infection, you go and get treatment for it, you should be able to apply through your hospital to have that coverage covered by the federal government.
What protections exist for uninsured COVID-19 patients seeking care?
But however, with other types of patients, there are certainly some cracks that people are vulnerable to slipping through.
Okay, so how about people who have insurance? For people covered by Medicare, what has their experience been like?
Well, Medicare generally is a pretty expansive program. It covers most of the ailments and procedures that Americans who have it need, particularly older Americans. But there are about 10% of Medicare patients, there's about 6 million people in America don't have what's called supplemental insurance, which is also called gap insurance. The result of that is that if you have a long hospital stay, you know, more than two or three weeks for COVID-19, and a lot of outpatient care, and perhaps even a lot of prescription medicine that you need to take, Then if you don't have this gap insurance, you might end up paying a big out-of-pocket bill because you still have to cover the 20% cost sharing that Medicare basic asks of beneficiaries.
And the reason for that is unlike the private insurers, Medicare has not suspended cost sharing for COVID-19.
Why are some Medicare beneficiaries still facing large out-of-pocket COVID-19 costs?
And secondly, Medicare has never had an out-of-pocket spending limit like most private insurance plans have. And this is sort of a political football that's been kicked around since at least the 80s when every few years someone in Congress will say, we should really limit how much Medicare beneficiaries can pay out-of-pocket so fewer people – who have chronic illnesses or big unexpected medical procedures don't go broke. And it's always been opposed by the private insurance industry because the private insurance industry, of course, does a great business providing gap insurance to cover exactly these costs.
Okay, so what sorts of numbers are we talking about in terms of costs to Medicare recipients?
One of the reasons why we wanted to do this story in the first place was because there were a lot of reports coming out about the sticker shock of COVID-19 treatment. So someone would come home from the hospital with a bill for $100,000, $200,000, $400,000, $500,000 worth of treatment from long hospital stays, ICU visits, ventilators,
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Chapters
8 chapters
1
What is the main topic discussed in this episode?
0:05–1:20
2
What government actions aimed to make COVID-19 testing and treatment free?
1:20–1:29
3
How do provider relief funds work and who uses them?
1:29–2:06
4
What protections exist for uninsured COVID-19 patients seeking care?
2:06–3:12
5
Why are some Medicare beneficiaries still facing large out-of-pocket COVID-19 costs?
3:12–5:02
6
How much are COVID-19 hospital bills and what do patients actually pay out of pocket?
5:02–6:46
7
What paperwork and diagnosis challenges prevent patients from getting COVID-19 costs covered?
6:46–9:12
8
Could insurer waivers and federal funding lapses cause bigger bills in a second wave?
9:12–11:05
Speakers
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