A new analysis finds that most people with individual or fully-insured group market coverage are in plans that waived cost-sharing for COVID-19 treatment, though many of those waivers are set to expire in the coming months.
About 88% – nearly nine in ten – enrollees in the individual and fully-insured group markets are covered by plans that have taken action to limit out-of-pocket costs for patients undergoing treatment for COVID-19 since the start of the pandemic. However, after accounting for waivers that have already expired (20%) or are scheduled to expire by the end of September (16%), just over half of enrollees in these plans will still be eligible for waived cost-sharing in October and beyond.
The estimates do not include the 61% of group market enrollees in self-insured plans through their employers. While many people with job-based health insurance may be covered by private insurers that are waiving cost-sharing for COVID-19 treatment, if their plan is self-insured, their employer can opt out extending cost-sharing and other financial relief to employees.
While emergency federal legislation has made COVID-19 testing available at no cost to most people, there is no federally mandated limit on out-of-pocket costs for COVID-19 treatment. KFF estimates that an inpatient admission for COVID-19 treatment could generate more than $1,300 in out-of-pocket costs for a person in a large employer-sponsored plan and costs could be much higher for people who are severely sick; the average costs that enrollees in individual and small group market plans can expect to pay may also be higher, given that these plans typically have higher deductibles. Additionally, enrollees in plans that waive cost-sharing for COVID-19 treatment may still be responsible for costs associated with the use of out-of-network providers or services.
The brief also finds that a smaller number of enrollees (23%) in individual and fully-insured group market plans are eligible for some form of premium relief amid the pandemic, including premium credits or reductions, grace periods for premium payment, and/or expedited Medical Loss Ratio (MLR) rebates.
A related analysis examines steps private insurers have taken expand the use of telemedicine during the pandemic, including waived cost-sharing for plan enrollees.
The issue brief is available on the Peterson-KFF Health System Tracker, an online information hub dedicated to monitoring and assessing the performance of the U.S. health system.