Unvaccinated? Here is why you may be paying extra for well being care prices quickly


The price of not staying vaccinated against COVID-19 is increasing day by day.

The cost of denying increasingly frequent workplace vaccination requirements could mean regular testing or no paycheck at all.

In some cities with vaccination records, this can mean a missed chance for a meal in a restaurant or a drink in a bar.

And as the open enrollment season for health insurance plans for many employers approaches, experts say not vaccinating is likely to come with higher healthcare costs in the future too.

The higher costs could include new surcharges for the monthly health insurance premiums. Unvaccinated people who become infected with COVID-19 could also have higher expenses for COVID-19 treatments and hospital stays, as many health insurance companies that previously fully covered these costs no longer cover these costs.

As companies wait for details on a federal rule requiring employers with at least 100 workers to require vaccinations or regular testing, the question arises whether workers will be held responsible for the financial burden – either directly for the tests themselves or indirectly, in future costs .

The increased health care costs in question should give further impetus to vaccination, according to Professor Kosali Simon, who teaches health economics and public policy at Indiana University. “It builds on the fact that there are other costs,” said Simon.

Namely to employers and insurance companies – two actors with the means and the motivation to make changes. “I see many employers investigating the legality of introducing surcharges,” said attorney Natalie Nathanson, a director of the Jackson Lewis law firm, where she advises management on their benefit plans.

Employers keeping an eye on the supplement see it as a potential incentive to vaccinate, which in turn can prevent lost productivity from sick staff and lower the bottom line of health insurance costs, she said.

Open enrollment is an annual fall window during which people can begin, end, or change the scope of their health insurance (in addition to certain “life events” such as losing their job or taking in a baby).

This year comes a time when nearly 20% of the American population have not yet received a vaccination against COVID-19, data from the US Centers for Disease Control and Prevention shows. The following must be observed under the given circumstances.

COVID-19 treatment waivers are disappearing

Insurers must fully cover medically necessary COVID-19 tests, and vaccines are free to the public. Here’s where the change comes, if it hasn’t already been: Insurance companies may no longer forego the costs that people pay for treatment and hospitalization.

This is what researchers from the Kaiser Family Foundation and the Peterson Center on Healthcare say.

Almost three quarters (72%) of the largest private insurers in the 50 states and the District of Columbia are waiving co-payment for COVID-19 treatment, the researchers said in August. By the end of October, the proportion of insurers who no longer pay the full bill could rise to over 80%.

At the start of the pandemic, 88% of those enrolled were covered by plans that waived co-payment for COVID-19 treatment, they said. Vaccines changed the equation, they said.

According to Krutika Amin, deputy director of the Kaiser Family Foundation, insurance companies had to make a decision. “Now that vaccines are more widely available, should avoidable COVID-19 hospital admissions be dispensed with compared to other treatments?”

According to a CDC analysis of the cumulative COVID-19-associated hospitalization rate, the likelihood of unvaccinated people being hospitalized by the end of August was about 12 times higher.

The average annual deductible for an employer-sponsored plan was $ 1,644 last year, data from the Kaiser Family Foundation showed. Hospitalization expenses for pneumonia, a disease that could require similar treatments to COVID-19, averaged $ 1,300, the researchers found.

Anthem ANTM, + 0.68%, is an insurer that waived the out-of-pocket expenses for COVID-19 treatment but later stopped.

The exemptions ended in January “as we all had a better understanding of the virus and people and communities became more familiar with best practices and protocols for limiting COVID-19 exposure and spread,” a spokesman said.

“It was also at this point that vaccines, which have proven to be the safest and most effective way to protect against COVID-19, became readily available,” he added. “We continue to encourage anyone eligible to be vaccinated to protect themselves and their families.”

Similarly, Aetna CVS, + 0.76% in February, ended treatment exemption under various government plans – but still covers vaccinations and testing. “In order to keep members safe during the COVID-19 pandemic, Aetna continues to offer member exemptions, such as: B. in connection with COVID-19 vaccinations and tests, “said a spokesman.

“COVID-19 vaccines and diagnostic tests will continue to be 100 percent covered by Aetna in accordance with federal guidelines. Our focus remains on encouraging Americans to get vaccinated and making the vaccination process as convenient as possible. “

Surcharges for unvaccinated employees

Although life insurances can offer different tariffs depending on the vaccination status, the health insurance companies cannot charge different premiums. (There’s an exception for smokers, she noted.)

However, the vaccination status can affect a premium surcharge.

Delta Air Lines DAL, -1.63%, is the most notable workplace where this happens. Unvaccinated workers are expected to pay an additional $ 200 monthly fee next month. Hospital stays related to COVID-19 cost the wearer an average of $ 50,000, CEO Ed Bastian said in an announcement in late August.

Two weeks after the award was announced, the company’s vaccination rate rose four percentage points to 78%. A spokesman said 90% of the 75,000 employees were fully vaccinated by Wednesday.

Although some of Nathanson’s employers are weighing the idea of ​​bonuses, some surveys suggest that bonuses are few and far between. Three percent of employers either had a bonus or were definitely planning one, according to a survey by recruitment firm Mercer earlier this month. Another 14% are considering the idea, according to the survey with more than 1,000 participants.

“Employers may not see a bonus as a huge advantage over a mandate – especially those who are already concerned about affordability of health care,” researchers wrote.

According to Dr. Jeff Levin-Scherz, director of public health at Willis Towers Watson WLTW, surcharges may not take hold, + 0.36%,
which also offers personnel consulting. The allowance is mixed in with the paycheck, so it could be difficult for workers to experience the extra pinch and then decide to get their shots, he said. It could lead other workers to drop out of health insurance altogether to save costs, he added.

Some previous research suggests wellness programs do just so much to change long-term behaviors, such as going to the gym, Simon said. However, the COVID-19 vaccination is a quick, short-term measure that requires a vaccination or two. In this context, the results of an award may vary – but that remains to be seen, said Simon.

Who pays for workplace tests?

There are the COVID-19 tests, which are linked to medical necessity, but then there are the so-called “surveillance tests” to look for a possible infection in the workplace.

These types of tests “may be considered” medically inadequate “so employers can keep their pockets,” said Fisher Phillips’ attorneys. “For some employers with significantly low vaccination rates, the cost of testing can be tens of thousands each week,” they noted.

According to Levin-Scherz, many states will not allow employers to make their workers pay for tests. But it’s an open question what the upcoming federal regulations will say, noted Nathanson.

Spokespersons for the Department of Labor’s occupational health and safety department, which writes the rule, did not respond to a request for comment. Some Republican governors have said they are ready to fight the rule in court.

Even if federal authorities say employers are hooked, it could still matter to workers, Levin-Scherz said.

“All an employer has to do to keep employees is money is being spent on it and not available on wages,” he said. The impact might “not be apparent this month, this year, but the amount of money spent on total compensation reflects the total cost.”

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