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Assessment of Out-of-Pocket Spending for COVID-19 Hospitalizations in the US in 2020

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  How much were patients billed for COVID-19 hospitalizations in the US in 2020?

Findings  In this cross-sectional study of 4075 COVID-19 hospitalizations in 2020, 71.2% of privately insured patients and 49.1% of Medicare Advantage patients had cost sharing for any hospitalization-related service, including those billed by clinicians; 4.6% of privately insured and 1.3% of Medicare Advantage had cost sharing for facility services billed by hospitals, with mean out-of-pocket spending of $3840 and $1536, respectively.

Meaning  The findings suggest that out-of-pocket spending for COVID-19 hospitalizations may be substantial if insurers allow cost-sharing waivers to expire.

Abstract

Importance  Many insurers waived cost sharing for COVID-19 hospitalizations during 2020. Nonetheless, patients may have been billed if their plans did not implement waivers or if waivers did not capture all hospitalization-related care. Assessment of out-of-pocket spending for COVID-19 hospitalizations in 2020 may show the financial burden that patients may experience if insurers allow waivers to expire, as many chose to do during 2021.

Objective  To estimate out-of-pocket spending for COVID-19 hospitalizations in the US in 2020.

Design, Setting, and Participants  This cross-sectional study used data from the IQVIA PharMetrics Plus for Academics Database, a national claims database representing 7.7 million privately insured patients and 1.0 million Medicare Advantage patients, regarding COVID-19 hospitalizations for privately insured and Medicare Advantage patients from March to September 2020.

Main Outcomes and Measures  Mean total out-of-pocket spending, defined as the sum of out-of-pocket spending for facility services billed by hospitals (eg, accommodation charges) and professional and ancillary services billed by clinicians and ancillary providers (eg, clinician inpatient evaluation and management, ambulance transport).

Results  Analyses included 4075 hospitalizations; 2091 (51.3%) were for male patients, and the mean (SD) age of patients was 66.8 (14.8) years. Of these hospitalizations, 1377 (33.8%) were for privately insured patients. Out-of-pocket spending for facility services, professional and ancillary services, or both was reported for 981 of 1377 hospitalizations for privately insured patients (71.2%) and 1324 of 2968 hospitalizations for Medicare Advantage patients (49.1%). Among these hospitalizations, mean (SD) total out-of-pocket spending was $788 ($1411) for privately insured patients and $277 ($363) for Medicare Advantage patients. In contrast, out-of-pocket spending for facility services was reported for 63 hospitalizations for privately insured patients (4.6%) and 36 hospitalizations for Medicare Advantage patients (1.3%). Among these hospitalizations, mean (SD) total out-of-pocket spending was $3840 ($3186) for privately insured patients and $1536 ($1402) for Medicare Advantage patients. Total out-of-pocket spending exceeded $4000 for 2.5% of privately insured hospitalizations compared with 0.2% of Medicare Advantage hospitalizations.

Conclusions and Relevance  In this cross-sectional study, few patients hospitalized for COVID-19 in 2020 were billed for facility services provided by hospitals, suggesting that most were covered by insurers with cost-sharing waivers. However, many patients were billed for professional and ancillary services, suggesting that insurer cost-sharing waivers may not have covered all hospitalization-related care. High cost sharing for patients who were billed by facility services suggests that out-of-pocket spending may be substantial for patients whose insurers have allowed waivers to expire.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: August 16, 2021.

Published: October 18, 2021. doi:10.1001/jamanetworkopen.2021.29894

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Chua KP et al. JAMA Network Open.

Corresponding Author: Kao-Ping Chua, MD, PhD, Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan Medical School, 300 N Ingalls St, SPC 5456, Room 6E18, Ann Arbor, Michigan 48109-5456 (chuak@med.umich.edu).

Author Contributions: Dr Chua had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Chua, Conti.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Chua.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Chua.

Obtained funding: Chua.

Administrative, technical, or material support: Conti.

Supervision: Conti.

Conflict of Interest Disclosures: None reported.

Funding/Support: Funding for purchase of IQVIA data was provided in part by the Susan B. Meister Child Health Evaluation and Research Center at the University of Michigan Medical School. Support was also provided by grant 1K08DA048110-01 from the National Institute on Drug Abuse, National Institutes of Health (Dr Chua).

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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