Unvaccinated to Pay More Out-of-Pocket Under New Covid Policies

As Covid-19 becomes part of regular life, health insurers anticipating losses are becoming less accommodating than they used to be, a change that will hit unvaccinated people the hardest.

Wide vaccine availability has caused some insurance companies to begin charging patients copays and deductibles for Covid-19 care that they waived at the beginning of the pandemic.

“The policy change affects everyone equally in theory, but unvaccinated people are more likely to end up in the hospital,” said Cynthia Cox, a vice president at Kaiser Family Foundation and director of its Program on the Affordable Care Act.

In August, KFF and the Peterson Center on Healthcare found that of the two largest insurers in each state and D.C.—102 health plans in all—72% were no longer waiving these out-of-pocket treatment costs, and another 10% planned to phase out waivers by the end of October.

Studies show being fully vaccinated against Covid-19 provides significant protection against hospitalization, death, or a severe case of the virus. It can also reduce the risk of long Covid—physical, neurological, and mental health conditions caused by Covid-19 that linger for months after the initial illness.

In a study of 6,000 adults in the United Kingdom, the Office for National Statistics found those who were vaccinated with two doses at least two weeks before they tested positive for Covid-19 were 41.1% less likely to report symptoms of the virus 12 weeks later.

Unvaccinated Could Pay More

People who choose not to get vaccinated can’t be denied health insurance, but they could be forced to pay more for their coverage.

The Affordable Care Act prohibits private health insurers from denying someone coverage or charging higher premiums because of a pre-existing condition or their health status, which would include whether or not they’re vaccinated.

Short-term health plans are an exception. Those plans could turn down applicants who refuse the Covid-19 vaccine because they aren’t subject to ACA regulations.

The ACA allows employer wellness programs to charge unvaccinated workers a surcharge as long as it doesn’t discriminate against people with disabilities.

Employers may be reluctant to take that step in a tight labor market, said Sabrina Corlette, a research professor at Georgetown University. “I don’t get a sense it’s happening on a wide scale basis,” she said.

Delta Air Lines was one of the first companies to make this move, charging unvaccinated workers in the company’s health plan a $200 monthly surcharge. Last month, the Society for Human Resource Management reported that Nevada would start charging public employees and their adult dependents who are not vaccinated a surcharge on their state health insurance plan starting in July.

Health insurers in the individual marketplace can’t impose penalties for not being vaccinated.

Losses Expected

Medical experts are still trying to get a good sense of just how many people have long Covid and how many people could develop it in the future. The lack of data has forced health insurers to guess how much it will cost to care for these people.

“Most insurers will assume a worst case scenario because they don’t want to lose money,” said Gerard Anderson, a professor of health policy and management at Johns Hopkins University Bloomberg School of Public Health. As a result, he expects to see health care premiums go up.

Health insurance companies are already working on their rate proposals for 2023 and may try to recoup money they had to absorb.

In New York, health insurers have been told to use cost data from 2021 as a starting point, said Leslie Moran, senior vice president of the New York Health Plan Association, a trade group that represents 29 fully licensed managed care plans and prepaid health service plans in the state.

Moran said a lot of things plans had to pay for in 2021 and will continue to pay for in 2022, like Covid-19 vaccines and over-the-counter testing kits, were not factored into the 2022 rates.

“Plans are already expecting to see losses,” she said.

Long Covid Coverage

It could be a while before the public has a good sense of just how health insurers are treating people with long Covid.

Anderson said there won’t be data that shows what tests and treatments insurance companies are covering for at least another six to nine months, and it’s likely to vary. “You’re going to see differences by insurer, and you’re going to see differences by hospitals that put in the claim.”

There are anecdotal reports that some people with long Covid have had a hard time getting insurers to pay for the care they need. One doctor at Vanderbilt University Medical Center, who leads a support group for people with long Covid, told Bloomberg Law he was running into problems over the summer trying to order cognitive rehabilitation for his patients. Insurers weren’t viewing Covid-19 as causing a typical brain jury that requires that sort 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 said. “But not all insurers do it the same way.”