COVID-19 Costs to Medicare Beneficiaries – Who Pays for Those?

According to recent research, the COVID-19 virus has impacted America's aging population more than almost any other group. The diagnosis carries with it almost certain and dramatic changes in lifestyle and capacity for afflicted Medicare beneficiaries, many of whom are now concerned about the subsequent costs they may have to bear as a consequence of getting sick. While Medicare is working to address the challenges posed to this population by the virus, including how to cover those costs, some employed beneficiaries might find another resource through their worker's compensation insurance.    

Higher Age = Higher Risk of Serious Illness

The data suggest that Medicare beneficiaries or those who become eligible for that status within two years are more apt to get seriously ill should they contract the 2019 novel coronavirus. That reality is a major concern both for Medicare beneficiaries who have not gotten sick, as well as those who have employed it. As of winter 2021, over 62 million Americans were enrolled in Medicare, including those who engage through a Fee-For-Service model (FFS) and those who engage through a Medicare Advantage program (MA). 

Between January 1, 2020, and November 21, 2020, of those 62+ million seniors:

  • more than 1,929,000 Medicare beneficiaries had been diagnosed with the disease, and 
  • almost half a million (493,167) of those patients were hospitalized. 
  • Tragically, nearly one in five sufferers (19%) lost their lives to the disease while hospitalized, 
  • while another 5% were discharged from the hospital to a hospice facility. 
  • However, more than one in three (35%) could return home after recovering from the illness.  

Many in these groups also suffer from a co-occurring health condition, which complicates both the significance of their illness and their recovery and long-term capacity. A large percentage of the FFS beneficiaries (79%) were also diagnosed with high blood pressure (hypertension); 49% were also diabetic, and another 49% suffered from chronic kidney disease. 

Age + Illness = Expense

The age and complicated medical history of these seniors increase the likelihood that they'll suffer more significant damage due to the disease. That situation will almost certainly generate higher costs, as well, for both acute and long-term treatments, a fact which concerns over 80% of participants in a recent survey. Additional research indicates that they are rightfully concerned about a COVID-19 diagnosis's financial fall-out. Because of the variety of available Medicare plans and the varying terms each of those contracts contains, some Medicare beneficiaries will pay more for COVID-related healthcare services than others:

Basic Medicare

  • Many beneficiaries (6.1 million) carry only Basic Medicare coverage, which follows the standards set out in the original Medicare plan. These include Part A (hospital care) and Part B (outpatient care.) These COVID patients may receive a significant medical care bill depending on the severity of their sickness and the amount of time they've spent in the hospital:
  • The standard deductible for hospital care was $1,408 in 2020 (rising to $1,484 in 2021). This covers the first 60 days of hospitalization, after which they accrue a daily co-pay of $352 ($371) for up to 90 days. If further hospitalization is needed after that, the daily rate of $704 ($742) is assessed and drawn from the participant's 'Lifetime Reserve."   
  • Those 'basic" patients who move to a skilled nursing facility pay no co-pay for the first 20 days, then accrue $176 ($185.50) through day 100. 
  • Outpatient doctor's visits, delivered through Part B, have a reasonable deductible of $198 ($203), while patients pay 20% of the cost of covered services. These costs are over and above the hospital fees accrued under Part A. 
  • Medicare Part D - prescription drug coverage - has no cap on spending, and deductibles can be as high as $445 (in 2021) depending on the specifics of the coverage and the drugs in question.  

Medicare Advantage Plans

Approximately 24 million beneficiaries receive their Parts A and B Medicare benefits from a Medicare Advantage program, which also usually includes prescription drugs. 

  • These programs often add additional premiums on top of what their participant already pays for basic Medicare, or they vary their standard deductibles and co-pays, depending on their structure.  
  • These additional fees usually change how Medicare pays for the services. In some cases, patients don't pay a deductible for hospital care but instead pay a daily co-pay for those services.     
  • Many Advantage plans have also altered their 'standard cost-sharing' practices ('cost-sharing' refers to co-pays, deductibles, etc.) to reflect the significance of the COVID-19 concern. As early as March 2020, many such insurers were:
  • providing COVID-19 testing and treatment services at no cost;
  • waiving prior authorization requirements, allowing patients to access medical services at a much faster pace;
  • encouraging the use of Telehealth services to facilitate access to healthcare services by home-bound patients and those with limited mobility;
  • offering financial assistance to struggling providers striving to meet the demand driven by COVID-19. To date, they've advanced millions of dollars to cover claims payments and even provided direct donations to service providers that need the support to maintain their level of service. 
  • Not insignificantly, these insurers are also directly supporting vulnerable populations, including donating to food services for families and older Americans and supporting emergency healthcare services to vulnerable people that inhabit society's fringe, including the homeless.    

Medicare Advantage plans also cap annual out-of-pocket costs; in 2021, that figure is $7,550.

Medicare Costs Looking Forward

Medicare is also looking ahead to determine how it can assist the country in meeting its future COVID-19 threats:

  • lab tests,
  • antibody tests,
  • monoclonal antibody treatments for those with a positive diagnosis who have mild or moderate symptoms, and have high-risk factors that the disease might advance more rapidly in their case, and
  • telehealth services to reduce the need for face-to-face exposures. 

The cost to Medicare for COVID-19-related care was estimated at approximately $7.4 billion just for FFS COVID-19 hospitalizations between January 1 and November 21, 2020, with an average of $23,500 per hospitalized case. 

  • Further, while all available data remains unclear, in June 2020, some entities estimated that the total spending to address and curtail the pandemic might reach as much as $546.6 billion by the end of 2021. Hospitalizations appear to account for a significant portion of that value. 
  • The same research indicates that consumers may face out-of-pocket costs of up to $1,300 over the course of their illness, which, when aggregated across the entire population, would total an additional $2.8 to $48.6 billion. To the extent that these consumers are also seniors, those extra costs may represent the difference between treatment and eating or heating or rent. 

Another Payment Alternative

Despite the pandemic, many Medicare beneficiaries continue to work. A 2017 survey indicated that the 'Baby Boomers' (those born between 1946 and 1964) were not interested in retiring early. The employment growth rate for their 65-74-year demographic was likely to surpass 60% between 2014 and 2024. Clearly, COVID-19 has slowed that progress, but there are still millions of seniors who continue to work despite the turmoil caused by the disease. Sometimes that work may increase their risk of experiencing a COVID-19 exposure. 

If or when that exposure occurs, many of these workers may have another option instead of Medicare to cover their COVID-related healthcare costs. Many states now recognize that COVID-19 can be contracted through employment-related activities and therefore can be considered a 'workplace injury' for purposes of receiving workers' compensation insurance coverage. However, if or when they make that claim, they should also be sure to establish a Medicare Set-aside Account (MSA) to protect their Medicare funding for future healthcare costs that are unrelated to their COVID experience. 

Today's Medicare recipients and eligibles are facing more than just a devastating health threat; they are also contemplating possible impacts on their economic situation should they contract the virus. However, those who are working may have the opportunity for their worker's compensation insurer to pick up COVID-19 related costs to preserve their Medicare healthcare funds for future use. They should explore that possibility at the first sign of illness,