Steeper medical bills to come
Earlier in the pandemic, most major health insurers voluntarily waived costs associated with Covid treatment. Most tests were free, too.
During this new wave of cases, a routine coronavirus test or a lengthy hospitalization will likely cost Americans significantly more, my colleague Sarah Kliff reports.
That’s largely because vaccines have long been available to adults across the country, so insurers are now treating Covid-19 like any other disease.
Some companies, like Delta Air Lines, are also planning to charge unvaccinated employees higher rates for insurance, citing in part the high hospitalization costs for Covid cases.
“Insurers are confronting the question about whether the costs of Covid treatment should fall on everyone, or just the individuals who have chosen not to get a vaccine,” said Cynthia Cox, a vice president at the Kaiser Family Foundation who has researched how insurers are covering Covid treatment.
Federal law still requires insurers to cover testing when there is a medical reason, like a display of symptoms or exposure to the virus, but many tests don’t meet that definition.
For example, the rules include exemptions for routine workplace and school testing, which has become more common as students head back to the classroom and as companies mandate regular testing for unvaccinated workers.
Some patients have already received testing bills as high as $200 for routine screenings, according to a Times project tracking the costs of Covid care. (If you’ve received a bill, you can submit it here.)
And although some employers will cover the cost of tests for unvaccinated workers, many others, including some hotels and universities, will not.
Seventy-two percent of large health plans are no longer fully covering the costs of Covid treatment for patients, a recent study from the Kaiser Family Foundation found.
In Florida, which is experiencing one of the country’s worst outbreaks, the state’s largest health plan ended free treatment on Wednesday.
Oscar Health, which sells coverage in Florida and in 14 other states, also ended free Covid treatment this week. It cited the widespread availability of the vaccine as a key reason.
“We started waiving cost sharing for Covid-19 treatment at the peak of the pandemic in 2020, when there were few options available for those who fell ill with the virus,” a spokeswoman said.
Although many pointed to vaccines as explanation, the new policies generally apply to all patients, including vaccinated people who get breakthrough infections and children under 12, who are not yet eligible for vaccines.
Most insured patients won’t pay the entire bill, which some research finds to be about $40,000 on average for a hospitalization; they will face whatever share they owe through deductibles and co-payments. Research published this summer found that for patients who had to pay a share of their hospitalization costs, the average cost was $3,800.
The unvaccinated older adults
The U.S. prioritized older adults for vaccinations when the shots first became available, because they were the most vulnerable to Covid-19. And they are the group with the highest vaccination rate: About 92 percent of people older than 65 have gotten at least one shot, and more than 80 percent are fully vaccinated.
But that leaves nearly 10 million older people without full immunization. And there are enormous regional variations. In New York City, rates for those over age 65 range from 80 percent on Staten Island to just 67 percent in Brooklyn. The rate falls below 50 percent in several Alabama counties and below 40 percent in stretches of New Mexico.
Understand Vaccine and Mask Mandates in the U.S.
- Vaccine rules. On Aug. 23, the Food and Drug Administration granted full approval to Pfizer-BioNTech’s coronavirus vaccine for people 16 and up, paving the way for an increase in mandates in both the public and private sectors. Private companies have been increasingly mandating vaccines for employees. Such mandates are legally allowed and have been upheld in court challenges.
- Mask rules. The Centers for Disease Control and Prevention in July recommended that all Americans, regardless of vaccination status, wear masks in indoor public places within areas experiencing outbreaks, a reversal of the guidance it offered in May. See where the C.D.C. guidance would apply, and where states have instituted their own mask policies. The battle over masks has become contentious in some states, with some local leaders defying state bans.
- College and universities. More than 400 colleges and universities are requiring students to be vaccinated against Covid-19. Almost all are in states that voted for President Biden.
- Schools. Both California and New York City have introduced vaccine mandates for education staff. A survey released in August found that many American parents of school-age children are opposed to mandated vaccines for students, but were more supportive of mask mandates for students, teachers and staff members who do not have their shots.
- Hospitals and medical centers. Many hospitals and major health systems are requiring employees to get a Covid-19 vaccine, citing rising caseloads fueled by the Delta variant and stubbornly low vaccination rates in their communities, even within their work force.
- New York City. Proof of vaccination is required of workers and customers for indoor dining, gyms, performances and other indoor situations, although enforcement does not begin until Sept. 13. Teachers and other education workers in the city’s vast school system will need to have at least one vaccine dose by Sept. 27, without the option of weekly testing. City hospital workers must also get a vaccine or be subjected to weekly testing. Similar rules are in place for New York State employees.
- At the federal level. The Pentagon announced that it would seek to make coronavirus vaccinations mandatory for the country’s 1.3 million active-duty troops “no later” than the middle of September. President Biden announced that all civilian federal employees would have to be vaccinated against the coronavirus or submit to regular testing, social distancing, mask requirements and restrictions on most travel.
That not only endangers that population, but it provides opportunities for the coronavirus to keep mutating in the bodies of those with weak immune systems.
It will be a struggle to inoculate older adults who are still unvaccinated. After soaring this spring, this population’s vaccination rate hit a plateau. Among 65- to 74-year-olds, 80 percent were fully vaccinated on July 1, creeping gradually to almost 84 percent by Sept. 1. Among those over 75, about 76 percent were fully vaccinated on July 1 and about 79 percent are now.
Some people cannot manage the online reservation. Others are homebound. Many refuse the vaccine, frightened by misinformation or turned off by partisan coverage, although polls suggest that the political divide that has led many Americans to resist vaccination is smaller in the older population.
And vaccine mandates from employers or schools will not affect most older adults. Instead, federal and local officials could bring vaccines to individual homes and neighborhood senior centers. They could provide transportation to pharmacies or clinics.
“We clearly need to do more in this extraordinarily vulnerable population,” said William Schaffner, an infectious disease specialist at Vanderbilt University. “They are not safe enough.”
What else we’re following
What you’re doing
We’re a family of physicians, and our saving grace of sanity throughout the pandemic has been our nightly Zumba routine. At the beginning, we all did it masked, but now that we’re all fully vaccinated, we do it unmasked. — Yair Saperstein, New York City
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