Americans with employer-based health insurance who contract severe cases of COVID-19, the disease caused by the coronavirus, could end up with out-of-pocket expenses that top $1,300, the Peterson-Kaiser Family Foundation Health System Tracker found.
That’s because individuals with employer and other private coverage typically need to meet a deductible before their coverage kicks in. About 82 percent of workers with employer-sponsored care had a deductible, with 55 percent reporting a deductible of over $1,000, the analysis found. The average deductible in employer-sponsored plans is $1,396.
Health researchers based their estimates on the costs associated with pneumonia. Although the majority of people who contract COVID-19 suffer only mild, cold-like symptoms, the disease can cause pneumonia and lead to organ failure and death. The U.S. has the most cases in the world, with 85,966 reported, according to a database maintained by Johns Hopkins University, and 1,300 deaths.
“The thought is, how we treat pneumonia is going to look a lot like how we treat the coronavirus,” said Matthew Rae, associate director for the Program on the Health Care Marketplace at the Kaiser Family Foundation, who worked on the analysis. “Both are respiratory illnesses.”
The average cost for a pneumonia patient with major complications was $20,292 in 2018, although it ranges dramatically across the country, from $11,533 to $24,178. Without major complications, lower total costs are lower, averaging about $13,767 for people will less serious complications and $9,763 for those without any complications.
The cost would be even higher for Americans who don’t have health insurance.
According to a 2018 study published by the West Health Institute and NORC at the University of Chicago, 44 percent of Americans have admitted to skipping a recommended medical test or treatment because of the cost.
And in the past two years, the number of Americans without health insurance has increased, amid the Trump administration’s legal attacks on the Obama-era Affordable Care Act, according to the Kaiser Family Foundation. There are at least 27.9 million nonelderly individuals in the U.S. who lack insurance. A number of Americans said they don’t receive health care via their jobs, and one in five said they can’t afford it. Uninsured people are less likely than those with insurance to receive preventative care and services for major health conditions and chronic diseases.
Legislation enacted in response to the pandemic has ensured that COVID-19 testing is free for all Americans, after insurance companies agreed to waive co-pays. Although the Trump administration initially said that insurance companies would cover the cost of all treatment, a major health insurance lobby said the companies will not be doing so.