Expanding Essential Care Coverage is the Need of the Hour During COVID-19

The COVID-19 pandemic has exacerbated the financial status of the millions of Americans who are facing problem in affording their medical care costs. The effect of the spread of this pandemic is not just confined to the healthcare sector, as public health measures like social distancing have resulted in the closure of several organizations, and it is estimated that several million jobs will be lost by the summer. For COVID-19 patients, paying for food, rent, childcare, and medical services will be a challenge, and they will be required to take tough decisions. As a result, they will need to prioritize some essential aspects of their life over others.

The COVID -19 is expected to worsen the financial condition of millions of Americans who already struggle to manage their healthcare cost. 1 in 3 Americans reported that they avoided medical care due to cost in 2019. Around 68% of adults recently said that their decision to receive medical care on having symptoms of COVID-19 will depend upon the out-of-pocket cost that they have to pay. The average out-of-pocket cost for a hospitalization associated with COVID-19 was estimated to be $1,300 by the Kaiser Family Foundation for people who receive health coverage from their employer.

It is not that only people with commercial insurance are unable to afford essential clinical services, but even the Medicare enrollees, who are at higher risk of COVID-19 will find it difficult to pay their deductible amount and other out-of-pocket expenses. Seeing that around 40% of Americans are unable to spend $400 to cover unexpected expenses, the increasing number of vulnerable Americans charged with thousands of dollars as out-of-pocket costs raise great concern.

To mitigate this acute problem exacerbated by the COVID-19 pandemic, policy solutions are devised, and a value-based insurance design has been implemented to ensure that people in need will be able to afford critical clinical services. In addition to it, the Families First Coronavirus Response Act was signed into law on March 18, which allow private plans to provide first-dollar coverage of telehealth services for COVID-19 care. The Coronavirus Aid, Relief, and Economic Security Act was enacted on March 27, to extend coverage to in-person visits for COVID-19 testing or screening. It also included coverage for all telemedicine services on a pre-deductible basis until the end of 2021. It also mandated all plans to cover future COVID-19 vaccines without any cost-sharing.

Medicare along with several other health plans have announced to provide COVID-19 coverage with no out-of-pocket costs, and some health plans have gone further and waive-off out-of-pocket costs for COVID-19 related hospitalizations. However, CMS issued regulatory changes on March 31 to support hospitals, doctors, and healthcare organizations’ abilities during this pandemic like expanding Medicare coverage of telehealth visits. Such measures should be quickly adopted that ensure the safety of healthcare professionals as well as patients.

In this testing time, out-of-pocket costs should be reduced and deductible should be expanded beyond COVID-19 care and must include other medical services like treatments for diabetes, depression, heart disease, and substance use disorders. Reducing or eliminating out-of-pocket costs for preventive and essential health services may increase the use of those services, resulting in the improvement of overall health and in lowering total medical costs in some cases. The act of reducing out-of-pocket costs was initiated by the private companies that were later successfully implemented in the ACA that provides free preventive care to over 130 million insured Americans.

Some of the federal policies that have been recently designed to lower the patient’s financial burden are Notice 2019-45. It allows high deductible health plans the flexibility to cover certain medications and services that are used in the treatment of chronic diseases before meeting the plan deductible, along with the recently announced Medicare Part D Senior Savings Model that reduces the out-of-pocket cost of insulin for around 3 million Medicare beneficiaries.

There might be concerns that generous coverage of high-value medical care will increase expenditures resulting in more premiums. This enhanced coverage can be funded by reducing a small portion of the $345 billion spent annually in the United States on low-value clinical services. The new benefit design model targets low-value care and increases access to high-value services without increasing premiums and deductibles. The current policies that lower out-of-pocket costs are voluntary or limited to certain individuals. Relief for patients unable to pay for medical care cannot be guaranteed without immediate action. For these policies to be successful, all stakeholders need to rapidly response like healthcare companies, pharmaceutical benefit managers, and health plans.

A flaw in the current benefit designs has been exposed by this pandemic that affordable coverage for critical services is not provided like COVID-19 treatment cost. Thus, the time has come for both public and private health insurance companies to revamp their benefit design and bear a larger part of the essential medical care cost. Due to this, Americans adversely affected would benefit a great deal.

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