Out-of-pocket spending for influenza hospitalizations in Medicare Advantage

Hundreds of thousands of Americans have been hospitalized for COVID-19. To date, most insurers have waived cost-sharing for COVID-19 hospitalization. However, these waivers are voluntary and can expire at any time. The objective of this study was to assess the potential cost-sharing for COVID-19 hospitalizations if waivers were not in place. To achieve this objective, we estimated mean out-of-pocket spending among 14,000 elderly Medicare Advantage enrollees hospitalized in 2018 for influenza, a virus that requires similar care as COVID-19. We found that the average enrollee paid $987 out-of-pocket for their hospitalization; for 3% of enrollees, out-of-pocket spending exceeded $2,500. Out-of-pocket spending was higher when intensive care was required and rose as length-of-stay increased. Findings suggest that Americans hospitalized with COVID-19 would be faced with substantial bills if cost-sharing waivers expire, causing financial stress that would compound the already substantial physical and emotional toll of COVID-19 hospitalizations. Rather than rely on voluntary actions by insurers, federal policymakers should consider mandates requiring insurers to waive cost-sharing for COVID-19 hospitalizations throughout the duration of the pandemic.

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