COVID-19 Patients May Face More Costs As Assistance Programs End

Federal aid programs have ended and most major U.S. insurance companies no longer are covering 100 percent of costs for coronavirus-related treatment. That means infected patients who require treatment could face large medical bills for hospital stays and other related care.

New data obtained by The Gazette show costs for a COVID-19-related stay at the state's largest hospital — which likely has seen the highest number of hospitalized coronavirus patients in Iowa throughout the past two years — reached an average of tens of thousands of dollars.

The average cost of care for a COVID-19 patient hospitalized at the University of Iowa Hospitals and Clinics in 2020 was $27,435. In 2021, it was $34,031, according to hospital data provided to The Gazette.

For COVID-19 patients in critical care, the average cost was $46,643 in 2020, and $60,599 in 2021, officials say.

At UnityPoint Health-St. Luke's Hospital in Cedar Rapids, the average cost per discharge was about $15,000, hospital officials previously told The Gazette. Approximately 1,600 COVID-19 patients were discharged from the hospital in 2020 and 2021.

Costs reached as low as $1,000 for those with short hospital stays, which included both those with less severe illness as well as those who died shortly after admission.

At the other end of the financial spectrum, costs exceeded $250,000 for those with prolonged hospital stays, hospital officials said.

UIHC reported no uninsured patients in 2020, and only two patients who were true "self-pay" in 2021. Officials said most patients were able to use the COVID-19 Uninsured Treatment Fund, a federal program through the Health Resources and Services Administration that reimbursed claims for testing and treatment for underinsured people.

Increasing medical debt

But that program officially ended on March 22, meaning patients with no health insurance who are hospitalized because of COVID-19 no longer will have 100 percent of their expenses covered.

This comes as most major insurance companies in the United States no longer are waiving co-pays, co-insurance and deductibles for COVID-19 treatment. That includes Wellmark Blue Cross and Blue Shield, the largest health insurer in Iowa, which officially ended its cost-sharing waiver on June 30, 2021.

In the early days of the pandemic, insurance companies waived cost-sharing requirements for people hospitalized with COVID-19. Therefore, the majority of fully insured Americans would not have had any out-of-pocket expenses.

That was the case for Wellmark's fully insured and Medicare supplement members who sought inpatient and outpatient treatment from Feb. 4, 2020, through June 16, 2020.

From June 17, 2020, through June 30, 2021, Wellmark shifted the cost-sharing waiver to apply just for inpatient treatment received from an in-network provider, according to officials.

It's unclear how many COVID-19 patients in Iowa would be directly affected by the end of these waivers from the federal government and private insurance companies, but local financial counselors who help residents get out of medical debt did see an uptick in client needs related to the pandemic in the past year.

"Over past few years, we've seen a trend of increasing medical debt presence overall," said Kelzye Bedwell, director of the Financial Wellness Center at Horizons, a not-for-profit based in Cedar Rapids.

The center provides free financial counseling services to area residents.

That trend is related to the pandemic, but it's also driven by the various health impacts clients have seen because of that, such as job loss or the loss of health insurance, Bedwell said.

"Even if they were not hospitalized, if they lost their job or experienced decreased income, that can affect their health insurance. So even basic medical needs are causing medical debt," she said.

Medicaid is required to cover COVID-19 testing and treatment for most enrollees and may not charge cost-sharing for this care, federal officials have said.

The cost of COVID-related hospitalizations for 4,283 Iowans under Medicaid was $29,157,074 for calendar year 2021, according to a brief from the Iowa Department of Human Services obtained by The Gazette.

According to the state's data, 1,692 Medicaid members under the managed-care organization Iowa Total Care were hospitalized with COVID-19 that year, which totaled to $14,985,732.

Among those under Amerigroup, 2,591 were hospitalized with COVID-19 in 2021, totaling to $14,171,342.

There were nearly 762,000 individuals enrolled with a managed-care organization through Medicaid and Children's Health Insurance Program, or CHIP, as of Nov. 2021, according to state officials.

About 42 percent of enrolled members were fully vaccinated by January 2022, state data shows, but it should be noted not all members are of an age that qualifies them for a vaccine.

Those who receive coverage through Medicare, the federal health insurance program for those aged 65 or older, could face out-of-pocket costs.

A report from the federal Centers for Medicare and Medicaid Services calculated the cost from more than 1.14 million total hospitalizations of Medicare beneficiaries from January 2020 until March 2021. It determined the average cost was $24,033.

One year into the pandemic, Medicare payments for fee-for-service COVID-19 hospitalizations totaled to $16.6 billion, according to the CMS report.

Nationwide, most studies show the average cost of a hospital stay for COVID-19 patients has hovered around $20,000.

COVID-19 vaccines are effective in preventing hospitalization and serious disease, but vaccination rates have lagged in Iowa when compared to other parts of the country. As of Wednesday, 65.9 percent of Iowans aged five and older are fully vaccinated, according to the U.S. Centers for Disease Control and Prevention.

It's estimated COVID-19 hospitalizations among unvaccinated Americans resulted in $13.8 billion in preventable COVID-19 costs between June and November 2021, according to a brief published by the Peterson Center on Healthcare and the Kaiser Family Foundation.

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