Getting hospitalized for COVID can cost thousands of dollars. Here are the factors affecting the bottom line, and why the vaccine is still the most effective way to avoid the hospital—and the bills.
The public health crisis caused by COVID is undeniable, but the financial impact of the pandemic has been just as devastating for many people across the country. A survey conducted in June 2021 by The Commonwealth Fund, an organization advocating for affordable health care, found that almost half of the 5,450 adults surveyed were either diagnosed with COVID or experienced a loss of income—and struggled with medical debt at higher rates than those who were not affected by the pandemic in these ways. Black and Latinx respondents reported the highest number of medical bill and debt problems compared to white adults. The survey also showed that 35% of those who reported struggling with medical bills and debt used up all or most of their savings.
Besides the obvious physical and emotional toll of getting hospitalized for COVID, the treatment is costly. A recent analysis on COVID hospitalization costs by the Peterson-Kaiser Family Foundation Health System Tracker estimates that the average cost of getting treated in a hospital for COVID is $20,000, although data for all types of payers and hospitalizations are currently not available to the public. While COVID cases and new hospital admissions have decreased since mid-September according to the latest CDC data, there are still more than 57,000 people hospitalized for COVID, US News reports.
Here is what you need to know about the factors contributing to hefty medical bills that come with COVID hospital admissions, insurance coverage, and ways to potentially keep your costs down.
Length and severity of the case are among the multiple factors that increase the cost of COVID hospitalization
The length of a person’s stay varies depending on the severity of their case. That and the resources required to treat a certain patient are two of the biggest factors impacting the bottom line, says Suneet Singh, MD, an ER doctor and medical director at digital health tech company CareHive Health.
“Ultimately, the overall costs of COVID hospitalizations are driven by long stays, the need for multiple types of health care providers working together in comprehensive care teams, the various medications utilized, and the advanced nature of the durable medical equipment required,” says Dr. Singh. He adds other medical conditions a patient may have, such as hypertension, diabetes, heart disease, or compromised immunity also increase the chances of hospitalization—and come with their own additional costs.
“As resources and lengths of stay increased due to severity of disease, the use of equipment such as ventilators and the processes surrounding advanced respiratory care drove the averages up to $49,441 and 17.1 days,” explains Dr. Singh. These numbers are from an August 2021 study published in medical journal Annals of Internal Medicine.
Other factors that contribute to total hospitalization cost include whether the hospital is in-network or out-of-network, explains Molly Moore, chief health plan officer at health insurance start-up Decent. “Costs also vary per hospital—some hospitals charge more than others,” she adds.
Many health insurance providers are no longer waiving cost-sharing for COVID treatment
While public and private health insurance providers initially covered much of the costs of COVID-related expenses, insurance companies are now expecting patients to share more of the cost. A study by Peterson-KFF from November 2020 found that 88% of those enrolled in fully insured private health plans would have any out-of-pocket costs waived if they were hospitalized for COVID; that’s no longer the case.
“These cost-sharing waivers…started to be phased out in November 2020,” says Dr. Singh. An updated Peterson-KFF analysis on COVID insurance coverage reported that as of August 2021, 72% of the two largest health plans in each state (102 plans) are no longer waiving out-of-pocket COVID costs.
The reason? The availability, safety, and effectiveness of the vaccine makes most hospitalizations completely preventable. “Health insurance providers are now asking patients who are hospitalized due to COVID, and declined to get vaccinated, to share the cost of treatment, which can get expensive if it requires a lengthy hospital stay,” says Moore. Between June and August 2021, preventable COVID hospitalizations of unvaccinated adults cost over $5 billion.
Vaccines, masks, and social distancing are ways to avoid hospitalization and expensive medical bills
Unfortunately, there is not much that can be done to lower medical bills once you are hospitalized for COVID—but there are measures to take to prevent or significantly decrease the chances you will be. “The best way to stay out of the hospital with COVID (and avoid big bills) is to get vaccinated,” says Moore. The vaccine is free, regardless of insurance.
“The CDC cites a tenfold protective effect of the vaccine against hospitalization needs compared to a matched unvaccinated cohort,” says Dr. Singh.