Did People Delay COVID Care Because of Cost?
Lockdown orders during the early phases of the COVID-19 pandemic led to a massive increase in unemployment, leaving millions of workers without employer-sponsored health insurance, according to a report published earlier this year by the Commonwealth Fund. Those early days of the pandemic also saw about one-third of adults falling behind in paying bills or having problems affording household expenses like food or health insurance coverage, according to the Kaiser Family Foundation.
However, even those who did not lose their insurance may have faced – and continue to face – problems accessing treatments for COVID and other chronic diseases. That’s because out-of-pocket treatment costs are often so high that they essentially create a barrier to appropriate care.
According to one health insurance expert, “inpatient care [for COVID-19 treatments] is expensive, and so is outpatient care.” The expert says this is where patients’ cost-sharing comes into play, noting that for most patients who need COVID treatment in 2021, out-of-pocket costs won’t exceed $8,500, but that’s “still a huge amount of money and most people don’t have it sitting around.”
When Costs Create a Barrier to Care
Krista Zodet, HealthWell Foundation
“Recent data suggests that four in ten Americans would struggle to come up with $400 to cover an emergency,” said Krista Zodet, president and CEO, HealthWell Foundation. “When hit with the costs of a chronic or life-altering disease, they may be forced to choose between needed medical treatments and paying their rent, mortgage, or utility bills; buying food; or saving for the future. Some even declare bankruptcy.”
These out-of-pocket costs can have a chilling effect on the public’s willingness to seek care. In a Gallup poll conducted early in the pandemic (April 2020), 14 percent of U.S. adults reported they would avoid seeking health care for the two most common symptoms of COVID-19 (fever and a dry cough) due to concerns about their ability to pay for it. An earlier Gallup poll found that just over 13 percent of American adults (about 34 million people) report knowing of at least one friend or family member in the past five years who died after not receiving needed medical treatment because they were unable to pay for it.
People of color are especially affected by inconsistent health care due to underinsurance, according to Sherita Golden, MD, MHS, a specialist in endocrinology, diabetes and metabolism, and chief diversity officer at Johns Hopkins Medicine. She notes that being able to afford doctors’ visits, medications and equipment to manage chronic disease is essential to lowering the risk of death from COVID-19 and other conditions, adding that people of color have a higher burden of chronic health conditions associated with a poor outcome of COVID-19, including diabetes, heart disease and lung disease.
Affording treatments for chronic illness can also be an ordeal for Medicare patients, who have a median annual income of $26,000. That’s because, unlike private health insurance, Part D drug plans have no cap on patients’ five percent coinsurance costs once they hit $6,550 in drug spending this year (except for very low-income beneficiaries).
According to the Commonwealth Fund, “the economic recession caused by the pandemic has put current and future Medicare beneficiaries at financial risk. Many still in the workforce have lost jobs and will likely experience difficulty regaining employment.”
Extended Availability for Health Plans
For those under 65 who no longer have employer-sponsored health insurance, the federal Health Insurance Marketplace® offers a special enrollment period for the COVID-19 public health emergency, allowing people to enroll in or change Marketplace health insurance plans through August 15, 2021. After that date, those who lost health coverage through their employer or the employer of a family member in the past 60 days or those who expect to lose coverage in the next 60 days, also may qualify for a special enrollment period.
All Marketplace plans cover treatment for pre-existing medical conditions and can’t terminate coverage due to a change in health status, including diagnosis or treatment of COVID-19. All Marketplace health plans also cover COVID-19 diagnostic tests, even for those who don’t have symptoms or don’t know if they’ve been exposed to COVID-19. In addition, the federal government has declared that COVID-19 vaccines be provided free of charge to all people living in the United States, regardless of their immigration or health insurance status.
The Health Insurance Marketplace offers advice to those who can’t pay their premiums because of a hardship due to COVID19:
- Check with your insurance company about extending your premium payment deadline or ask if they will delay terminating your coverage because you can’t pay your premiums.
- Most of the time, if you aren’t receiving financial assistance with your premiums, you have a grace period determined by state law (often one month). If you’re getting financial assistance, you have a three-month grace period during which your coverage can’t be terminated for not paying your premiums.
- If your household income changed, update your application immediately. You could qualify for more savings than you’re getting now.
Patient Assistance Foundations Offer Relief
People struggling to pay treatment costs for chronic illnesses can also turn to charitable patient assistance programs (CPAPs) for financial assistance. One such CPAP is the HealthWell Foundation, sponsor of Real World Health Care.
In 2020, even as the COVID pandemic impacted the nation’s economy, HealthWell’s generous donors allowed the Foundation to award over $650 million in medication copayment and insurance premium assistance grants to nearly 170,000 underinsured Americans. In addition to its standard disease funds, HealthWell used its own financial resources – before being joined by other corporate and individual donors – to create two COVID-19 specific funds last year.
The first, launched on March 17, 2020, provided up to $250 in assistance to 8,330 qualifying households to help them afford food and medication delivery in support of social distancing requirements. The second, opened on April 28, 2020, provided up to $6,000 in financial assistance to 644 qualifying households, where the policyholder lost their employee-related private insurance during the economic downturn. This fund allowed the covered patient with either a serious, chronic or oncologic disease to continue their usual treatment programs.
In February of 2021, the Foundation opened its third, HealthWell-sponsored, COVID-19 fund to provide up to $2,000 in financial assistance for behavioral health services for COVID-19 frontline health care workers. Through the COVID-19 Frontline Health Care Workers Behavioral Health Fund, HealthWell assists frontline health care workers in covering their out-of-pocket treatment-related copayments for prescription drugs, counseling services, psychotherapy, and transportation needed to manage COVID-19 related behavioral health issues.
“It is during times like these that we realize just how fortunate we are to be able to continue making a difference in the lives of those so negatively impacted by the pandemic,” Zodet concluded.