The COVID-19 pandemic has had an extraordinary, unprecedented, and severe impact on virtually all aspects of life in the United States. The emerging impact of continued virus proliferation on the U.S. health care system will be immense. Wakely Consulting, in a recently released report, explored the potential COVID-19 testing and treatment cost implications to U.S. health insurance providers for 2020 and 2021.
Recognizing the extraordinarily wide range of potential outcomes and data limitations, Wakely compiled, for a range of assumed infection rates, estimates of the potential COVID-19-related costs for health insurance providers operating in the Commercial, Medicare Advantage, and Medicaid Managed Care lines of business.
The estimated costs range from $56 to $556 billion over the 2-year time period.
Estimated Range of Total COVID Associated Treatment and Testing Costs, 2020-2021
| Scenario | 2020 Range Total Allowed Cost (in billions) | 2021 Range Total Allowed Cost (in billions) | 2020-2021 Total Range of Allowed Cost (in billions) | 2020-2021 Total Range of Enrollee Cost Sharing (in billions) |
| Low Infection Rate (10%) | $42.2 – 69.5 | $14.1 – 23.2 | $56.2 – 92.7 | $10.0 – 13.0 |
| Baseline Infection Rate (20%) | $84.4 – 139.0 | $28.1 – 46.3 | $112.5 – 185.4 | $20.0 – 26.0 |
| High Infection Rate (60%) | $253.1 – 417.1 | $84.4 – 139.0 | $337.5 – 556.1 | $59.9 – 78.0 |
Modeling was performed based on emerging data and information available to Wakely as of March 28, 2020. Wakely relied on information from outside sources. Considering the extraordinary pace at which available data is evolving and changing, there is potential that analysis performed later could yield material updates to the scenario estimates and render the estimates outlined herein outdated. The Wakely report details the cost scenario modeling methodologies, source data, and limitations, and should be considered in its entirety. Variables may include the number of Americans who are asymptomatic, the impact of interventions such as social distancing, the availability of testing, and the length of hospital stays. Wakely did not include estimated savings to insurance providers as a result of individuals delaying or foregoing care which could have a material impact mitigating costs over the study period. The report also assumes reasonable pricing by labs, drug manufacturers, and providers. Consequently, actual results may vary from the Wakely estimates materially.
Additional details of Wakely’s cost scenario assumptions and results are presented below.
Population Assumptions in Baseline 20% Infected Scenario (Midrange), 2020-2021
| Assumption | Medicare Advantage | Commercial (Group + Non-Group) | Medicaid MCO | Total |
| Total enrollees | 24,480,000 | 176,700,000 | 54,180,000 | 255,360,000 |
| Total Number Infected
(includes those not tested) |
4,896,000 | 35,340,000 | 10,836,000 | 51,072,000 |
| Number Confirmed Cases | 3,380,000 | 24,690,000 | 7,540,000 | 35,610,000 |
Total Utilization and Cost per Utilizer Assumptions in 20% Infected Scenario, 2020-2021
| Service Category | Medicare Advantage | Commercial (Group + Non-Group) | Medicaid MCO | Total / Average |
| Total Utilization | ||||
| IP Hospital Services | 920,000 | 3,780,000 | 800,000 | 5,500,000 |
| Non-ICU | 660,000 | 2,930,000 | 610,000 | 4,200,000 |
| ICU | 260,000 | 850,000 | 190,000 | 1,300,000 |
| OP Hospital Services | 2,030,000 | 14,820,000 | 4,520,000 | 21,370,000 |
| Professional Services | 2,030,000 | 14,820,000 | 4,520,000 | 21,370,000 |
| All Other Services | 120,000 | 220,000 | 40,000 | 380,000 |
| Rx Services | 1,110,000 | 11,040,000 | 3,720,000 | 15,870,000 |
| Cost per Utilizer | ||||
| IP Hospital Cost | ||||
| Non-ICU | $8,850 | $12,450 | $6,800 | $11,050 |
| ICU | $17,000 | $38,450 | $16,250 | $30,950 |
| OP Hospital Cost | $600 | $1,000 | $460 | $850 |
| Professional Cost | $170 | $140 | $70 | $130 |
| All Other Cost | $4,850 | N/A | N/A | $20 |
| Rx Services | $90 | $110 | $130 | $120 |