Financial Risk for COVID-19-like Respiratory Hospitalizations in Consumer-Directed Health Plans

Eisenberg, Matthew D.; Barry, Colleen L.; Schilling, Cameron; Kennedy-Hendricks, Alene

INTRODUCTION: : This study aims to quantify out-of-pocket spending associated with respiratory hospitalizations for conditions similar to those caused by coronavirus disease 2019 (COVID-19) and to compare out-of-pocket spending differences among those enrolled in consumer-directed health plans and in traditional, low-deductible plans. METHODS: : This study used de-identified administrative claims from the OptumLabs® Data Warehouse (January 1, 2016–August 31, 2019) to identify patients with a respiratory hospitalization. It compared unadjusted out-of-pocket spending among consumer-directed health plan enrollees to traditional plan enrollees using difference of mean significance tests and repeated the analysis separately by age category and by calendar year quarter. These data were collected on a rolling basis by OptumLabs and were analyzed in March 2020. RESULTS: : Commercially insured consumer-directed health plan enrollees had significantly higher out-of-pocket spending than traditional plan enrollees and these differences were largest among younger populations. The largest difference in out-of-pocket spending occurred during the first half of the year. CONCLUSIONS: : Consumer-directed health plan enrollees may experience differential financial burden from a hospitalization related to COVID-19. Although some insurers are waiving cost-sharing payments for COVID-19 treatment, self-insured employers remain exempt. Policy responses to date may be insufficient to reduce the financial burden on consumer-directed health plans enrollees with respiratory hospitalizations related to COVID-19.