Insurance Companies Stop Waiving Out-of-Pocket COVID Costs

Ralph Ellis

August 20, 2021

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Americans may be hit with surprising bills in the future if they're hospitalized with COVID-19.

While vaccines and testing are still free, many insurance companies are no longer waiving out-of-pocket expenses for people hospitalized with the coronavirus, the Kaiser Family Foundation reports.

Early in the pandemic, 88% of people enrolled in fully insured private health plans would have paid little or nothing out-of-pocket if they were hospitalized with the virus, the KFF said.

As highly effective vaccines became widely available, however, about three-quarters of health plans have ended the practice, the KFF said. Costs are being passed to the consumer.

The KFF said it found that 72% of the two largest insurers in each state and Washington, D.C., had waived cost-sharing for COVID treatment. These 102 providers represented 62% of enrollment across fully insured individual and group markets, KFF said.

About half those plans ended cost sharing waivers in April 2021, when almost all U.S. adults became eligible for the vaccine, the KFF said. About 10% of other health plans will phase out waivers by the end of October.

Out-of-pocket costs were waived during the early part of the pandemic because hospitals and health care workers were overwhelmed with COVID-19 patients, the KFF reported.

"Insurers may have also wanted to be sympathetic toward COVID-19 patients, and some may have also feared the possibility of a federal mandate to provide care free-of-charge to COVID-19 patients, so they voluntarily waived these costs for at least some period of time during the pandemic," KFF said.

When widespread vaccinations began, health insurance companies no longer faced "political or public relations pressure to continue waiving costs for COVID-19 treatment," the KFF said.

"As more waivers expire, more people hospitalized for COVID-19 – the vast majority of whom are unvaccinated -- will likely receive significant medical bills for their treatment," the KFF said.

The typical deductible in employer health plans is $1,644, the KFF said. People hospitalized with pneumonia, which requires treatment similar to COVID-19, paid an average of $1,300 out of pocket, KFF said.

"Although this is a large amount to most patients, and could be an incentive to get vaccinated, it still only represents a fraction of the cost born to society for these largely preventable hospitalizations," KFF said.


Kaiser Family Foundation. "Most private insurers are no longer waiving cost-sharing for COVID-19 treatment"