Current and future patients hospitalized for COVID-19 will probably pay a significantly larger share of their treatment costs than did those hospitalized in 2020, and federal legislation may be needed to help them cope with those costs., a new study suggests.

When the pandemic struck the U.S last year, many commercial insurers voluntarily waived some out-of-pocket costs for patients hospitalized or admitted to emergency departments for COVID-19 treatment during all or part of the year. But many of those waivers either have expired or are scheduled to in the coming months, substantially increasing patients’ cost burden.

The authors analyzed claims for 4,075 COVID-related hospitalizations among 3,875 patients during 2020. Patients had insurance coverage either through a commercial insurer or a Medicare Advantage (MA) plan.

For purposes of the study, claims were divided into three categories: facility services, such as inpatient laboratory and pharmacy costs; professional and ancillary services, including claims for ambulance, clinician and miscellaneous charges; and unclassified charges that didn’t fit either of the other two categories.

Out-of-pocket spending was defined as the sum of deductibles, co-insurance and co-payments, and total out-of-pocket spending as the sum of facility, professional and ancillary services.

Relatively few of the patients—4.6% covered by commercial insurers and 1.3% with MA plans—had out-of-pocket expenses for hospital facility services, leading the authors to infer that the rest were covered by insurers that waived these expenses. For patients whose coverage did not waive them, mean spending amounts for these services were $3,840 for commercially insured patients and $1,536 for those with MA plans.

“The findings suggest that out-of-pocket spending for COVID-19 hospitalizations may be substantial if insurers allow cost-sharing waivers to expire,” the authors write, noting that as of August 2021, 72% of the two largest private insurers in every state, as well as several large MA insurers, have allowed their cost-sharing waivers to expire.

“The increasing trend towards abandonment of these waivers suggests that relying on voluntary actions by insurers is not an ideal strategy if policymakers wish to protect patients from the costs of COVID-19 hospitalizations,” they add. Achieving that goal, they say, might require legislation mandating insurers to waive cost-sharing for COVID-19 hospitalizations for the duration of the public health emergency.”

The study, “Assessment of Out-of-Pocket Spending for COVID-19 Hospitalizations in the US in 2020” was published October 18 on JAMA Network Open.