In an effort to cope with Covid-19, health insurers anticipate losses in a less accommodating manner than they were previously, which will hurt those who have not been immunized.
Some insurance companies have begun charging patients for Covid-19 care that was waived at the outset of the pandemic due to the widespread availability of vaccines, according to Bloomberg Law.
“The policy change affects everyone equally in theory, but unvaccinated people are more likely to end up in the hospital,” explained Cynthia Cox, vice president of Kaiser Family Foundation’s Affordable Care Act Program.
KFF and the Peterson Center on Healthcare reported in August that in the two largest insurers in Washington, D.C. 72% stopped waiving these out-of-pocket expenses and another 10% were planning to do so by the end of October.
In a study involving 6,000 United Kingdom adults, the Office for National Statistics found that those who received two doses of the vaccine at least two weeks before they tested positive for Covid-19 reported symptoms of the illness 41.1% (less frequently) 12 weeks later.
You Pay More If Unvaccinated
Health insurance won’t dispute those who refuse to get vaccines, but they (the unvaccinated) may have to pay more if they choose such a decision.
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According to the Affordable Care Act, insurance companies cannot deny coverage or charge higher premiums because of a pre-existing condition or their health status, such as vaccination status.
Health plans with short-term coverage are an exception. In these plans, applicants who are not covered by ACA regulations may not be accepted if they refuse Covid-19.
As long as it doesn’t discriminate against people with disabilities, the Affordable Care Act permits employers to charge unvaccinated workers a surcharge for wellness programs.
A tight labor market could further discourage employers from taking that step, Sabrina Corlette, a Georgetown University research professor, said.
“I don’t get a sense it’s happening on a wide-scale basis,” she said.
One of the first companies to do this was Delta Air Lines, which charged unvaccinated workers in its health care plan $200 a month.
Nevada will begin charging a surcharge to public employees and their adult dependents who are not vaccinated starting in July, according to an article by the Society for Human Resource Management.
The individual marketplace doesn’t allow insurers to penalize customers who don’t get vaccinated.
There Will Be Losses
The number of people who have long-term Covid, or could develop it in the future, is still not clear to medical experts.
Because of a lack of data, health insurers are forced to make educated guesses on how much care will cost.
A Johns Hopkins Bloomberg School of Public Health professor, Gerard Anderson said, “Most insurers will assume the worst because they don’t want to lose money.”
Because of this, he explained that health care premiums (prices) are likely to increase.
Plans for the 2023 rate proposals are already being worked on, and insurers may seek to recoup some of their losses.
The New York Health Plan Association, which represents 29 managed care plans and prepaid health service plans in the state, told health insurers to begin using cost data for 2021 as a starting point, Leslie Moran, senior vice president of the group, disclosed.
According to Moran, many things would be paid for in 2021 and this would continue into 2022.
“Plans are already expecting to see losses,” she said.
Covid Coverage for a Long Time
Anderson predicts that insurance companies won’t have data showing which tests and treatments they’re covering for another six to nine months.
“You’re going to see differences by the insurer, and you’re going to see differences by hospitals that put in the claim.”
Anecdotally, some people with long Covid periods reported having trouble getting their insurers to pay for their care.
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The head of a support group for people with long-term cognitive disabilities at Vanderbilt University Medical Center told Bloomberg Law he ran into difficulties ordering cognitive rehabilitation for his patients over the summer.
As he said, Covid-19 was not viewed by the insurers as a typical brain injury that requires that type of treatment.
“Insurers, especially private insurers, have a great deal of flexibility on what they choose to pay for and what they choose not to pay for,” Anderson added.
“But not all insurers do it the same way.”