The cost to insurers from COVID-19 could range from $56 billion to $556 billion over the next two years, according to a Wakely Consulting Group study that was done for America’s Health Insurance Plans.
AHIP retained Wakely to explore the potential cost implications of COVID-19 testing and treatment to health insurers for 2020 and 2021.
Outcomes will differ depending on the number of Americans who become infected but are asymptomatic, the impact of interventions such as social distancing, and the availability of testing.
Hospital costs could exceed Wakely’s estimates if average intensive care stays are longer, more expensive or require more services than estimated in these models.
WHAT’S THE IMPACT
The report considers the impact of COVID-19 to commercial, Medicare Advantage, and Medicaid managed care plans.
Assuming a 20% infection rate among the study population, the report estimates that more than 50 million Americans will become infected, with at least 5.5 million requiring hospitalization – of which 1.3 million will require intensive care.
For each person admitted into intensive care, costs, on average, could exceed $30,000.
The report assumes reasonable pricing by labs, drug manufacturers, and care providers. The report does not consider the impact of potential delays in care, which are unknown at this time, or large shifts in patients between product lines.
At the midrange scenario, 1.3 million people will require intensive care.
The report also considers the potential out-of-pocket costs consumers could experience for COVID-19 care. Wakely estimates enrollee cost sharing would, on average, be approximately 14-18% of annual allowed costs on average across lines of business modeled, and would range from $10 billion to $78 billion.
This figure does not take into account announcements made by health insurance providers that they are waiving out-of-pocket costs for COVID-19 testing and treatment.
THE LARGER TREND
Wakely’s findings are based on data and information available as of March 28. As the COVID-19 national emergency continues to evolve, AHIP and Wakely will revisit these findings and provide updates, AHIP said.
Many insurers have committed to cover costs for testing or treatment for COVID-19 and also to speed prior authorization approval.
ON THE RECORD
“This new data provides us with better insight to help policymakers, private sector leaders, and other stakeholders understand the investments required to successfully care for every American subjected to this life-threatening virus,” said Matt Eyles, AHIP president and CEO. “In these extraordinary times, costs should not be a barrier to anyone seeking treatment. This is why many health insurance providers have stepped forward to proactively waive out-of-pocket costs for testing and treatment.”
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