Most private payers reinstate cost sharing for Covid hospitalizations

August 31, 2021

With vaccines now readily available and receiving full FDA approval, most private payers have moved to reinstate cost sharing for Covid-19-related hospitalizations and treatments.

While cost sharing for Covid testing and vaccine administration continues to be barred under CARES Act provisions while the Public Health Emergency remains in effect, there is no federal law that requires payers to cover treatment costs for patients hospitalized with Covid. However, the vast majority of commercial insurers chose to voluntarily waive these costs beginning in November of 2020 and continuing this year.

According to a Peterson-Kaiser Family Foundation (KFF) Health System Tracker brief, 72 percent of the two largest payers in each state have ended cost-sharing waivers for COVID-19 treatment.

Individuals who do not receive the vaccine and subsequently require hospitalization for treatment when they contract the virus may be subject to a high bill under some health plans. The decision from payers to no longer waive out-of-pocket costs for these expensive Covid-related hospitalizations may provide an incentive for more Americans to receive the vaccine.

During June and July 2021, the US healthcare industry spent over $2 billion on Covid-related hospitalizations for patients who were unvaccinated.

Who's reviewing revenue strategy with you at this time?

Are you billing all the correct CPT codes? You’d be surprised at what you might be missing. We will review your Fee Schedule/Charge Master at no cost.

That’s right. For free.

Share This