Not vaccinated against COVID? It’s about to get very expensive

MIAMI – Up until now, insurance providers have been waiving co-pays and deductibles for COVID-19 medical care, but that will soon end.

In this “pandemic of the unvaccinated,” getting so sick with coronavirus that you end up needing medical care could soon have a substantial financial impact on insured patients.

“People can get enormous bills for this and it is going to wreak havoc on the health systems trying to collect that money,” said Ray Berry, founder and CEO of Health Business Solutions, a consulting group that works with hospitals and insurance companies.

“Anyone who has gotten COVID up until this point will not have paid, anything but that will sure change in the next month or two. I believe it will change quicker than some people might think.”

In fact, Aetna says deductible-free inpatient treatment for COVID-19 expired in late February.

“COVID-19 vaccines and diagnostic testing continue to be covered 100 percent by Aetna, in line with federal guidelines,” the provider said in a statement. “Our focus remains on encouraging Americans to get vaccinated and making the vaccination process as convenient as possible.”

And now, in a time of ample vaccine, a growing number of insurers are planning to end fee waivers for COVID treatment.

Florida Blue will be among them.

“Starting Sept. 1, Florida Blue will cover treatment for COVID-19 infections in the same manner we cover treatment for other respiratory illnesses such as pneumonia,” the insurer said in a statement. “All members will be responsible for any copays, coinsurance or deductibles outlined in their ACA individual, employer group or Medicare Advantage health plan benefits. Medical diagnostic testing for COVID-19, as well as vaccinations, continues to be available to members at $0 cost share.”

The end of fee waivers is for all patients — regardless of whether they were vaccinated — though medical experts have said that the vast majority of people hospitalized with COVID-19 were not inoculated.

“I can give you an example of some of the Broward County hospitals,” Berry said. “The average COVID patient costs around $17,000 upwards to about $25,000 to treat a length of stay is about 5-6 days. If you had an insurance plan with a 10% co-pay or a $1,500 deductible, you would be responsible for that deductible up to the $1,500 plus the 10%, so you could end up having a bill of $3,000 individually, the insurance company would cover the rest.

“The government has been paying for the uninsured. Medicare and Medicaid are paying for their portion and not charging any co-pays or deductibles on theirs.”

It can get pricey for ER visits and COVID hospitalizations, given that the labor-intensive care required is expensive.

The end of waivers could result in out-of-pocket costs ranging from $1,500 to $10,000+, depending on your insurer, the treatments and the length of a hospital stay.

“Easily it can exceed $10,000,” Berry said. “There are so many variations in insurance plans. Some people can have emergency room coverage only, some people have varied insurance plans through their employers, they could have much bigger cost-shares or deductibles, and those could be enormous. $10,000 is not unthinkable.

“I think for folks financially there is going to be a big change — it’s not just for them, for companies. My company in particular, the more people who get COVID and the insurance company has to pay, the higher my costs are going to be in the following year.”

Delta Airlines is one of the first major employers to announce it is hiking premiums for unvaccinated employees — a $200 monthly surcharge starting Nov. 1.

“A lot of companies are going in that direction because the cost of treating COVID is far greater than the cost of preventing it,” Berry said.

Delta’s CEO told employees their fee is necessary because the average hospital stay for COVID-19 has cost the company $50,000 per person. He said during the recent case surge all Delta employees who have been hospitalized with the virus were not fully vaccinated. (Click here to read the company memo.)

“We have over 80% of our crews, both pilots and flight attendants, are already vaccinated, so I think this last step, just short of a mandate, will work for us,” Delta CEO Ed Bastian said.

Said Berry: “They have hundreds and thousands of employees. With a positivity rate of 5 or 10%, it is crippling to them financially.”

American Airlines has taken a different approach, offering incentives for employees to get vaccinated.

“American’s team members who get vaccinated are provided an additional day off in 2022 and $50 through our employee recognition platform,” the company said.

Berry says he does think that companies who charge the unvaccinated more for insurance are “in for some legal challenges.”

“I think there are four different laws at play here,” he explained. “There is a hodgepodge of rules at play. It is going to be a difficult process for employers to figure out. It is a difficult road for all of us. My insurance, I have about 460 employees. I anticipate my insurance premiums going up considerably next year because of the impact of COVID.

“Up until now, we haven’t felt it, because of the government supplementing our costs. Businesses will bear the expense of COVID going forward, and that is going to be an issue for some companies.

Berry said he initially didn’t believe that companies could charge a different insurance rate for people who are unvaccinated, but his research showed that they can.

“You can’t do it technically as a penalty, but what they are doing is essentially adding as an employee wellness provision, and under the Affordable Care Act you can do up to 30% penalty or bonus based on employee wellness and on a vaccine,” he said. “However, Medicare, Medicare and under the Obamacare policies, if you buy an Obamacare policy, you can’t charge more for the unvaccinated than the vaccinated.”

As of right now, getting a COVID-19 vaccine remains free of charge. To see locations where you can get them in South Florida, click here.

More on Delta’s vaccine policies

“Effective immediately, unvaccinated employees are required to wear masks in all indoor Delta settings. This requirement will remain in place until community case rates stabilize.

• Starting Sept. 12, any U.S. employee who is not fully vaccinated will be required to take a COVID test each week while community case rates are high. Those with a positive result will need to isolate and remain out of the workplace.
• Beginning Nov. 1, unvaccinated employees enrolled in Delta’s account-based healthcare plan will be subject to a $200 monthly surcharge. The average hospital stay for COVID-19 has cost Delta $50,000 per person. This surcharge will be necessary to address the financial risk the decision to not vaccinate is creating for our company. In recent weeks since the rise of the B.1.617.2 variant, all Delta employees who have been hospitalized with COVID were not fully vaccinated.
• Effective Sept. 30, in compliance with state and local laws, COVID pay protection will only be provided to fully vaccinated individuals who are experiencing a breakthrough infection.”