As more Alabamians lose jobs and the state’s economy slows, hanging on to health insurance could be key to avoiding the most severe financial risks of getting the coronavirus, experts say.

Alabama Blue Cross Blue Shield told al.com it is waiving deductibles and co-pays for coronavirus treatment for its fully insured members.

But for the uninsured, hospital bills could be doubled, possibly even tripled. In severe coronavirus cases, bills for the those without coverage could be as high as $240,000, the Kaiser Family Foundation estimates.

That’s because uninsured patients who self-pay don’t benefit from the negotiated rates insurers get, experts say.

“I'm worried that with so many people losing their jobs right now... there's going to be a lot of people who fall through the cracks,” said Cynthia Cox, vice president of the foundation.

The CDC reports about 12 percent of coronavirus patients in the United States were hospitalized in an early report. Alabama is projected to have the 16th highest death rate from coronavirus nationwide, according to the Institute of Health Metrics and Evaluation at the University of Washington.

Researchers at the Kaiser Family Foundation reviewed hospital costs for pneumonia to estimate projected costs for coronavirus hospitalizations. Treatment for coronavirus may range from $20,000 to $88,000, depending on severity of the illness, according to the foundation.

While insurers may cover most of those bills for their members, the unemployed could end up paying two to three times the amount insurance companies are billed, Cox says.

“We really have no idea what hospitals are going to charge uninsured people."

If patients require a ventilator, with a typical hospital stay of 23 days, the costs go up significantly.

One non-profit focused on cost transparency in healthcare, FAIR Health, estimates COVID-19 costs for the uninsured could reach $75,000 for complications.

Cox says that study relies on billing codes that don’t necessarily include the cost of a ventilator.

An early House version of the federal stimulus bill included funding for coronavirus treatment which was dropped in the final Senate version. Cox says she expects the issue may be revisited by congress.

According to preliminary numbers, 66,638 filed for unemployment in Alabama as of March 31. There were nearly 81,000 claims the week prior.

Thomas Weida, chief medical officer for the University of Alabama, is worried big hospital bills could drive some Alabamians into deep financial trouble.

“It would probably mean bankruptcy for most of those folks,” he said of the most severe cases, adding that few estimates have factored in the cost of a recovery period post-hospitalization.

According to the Urban Institute, a Washington D.C., policy group, 21 percent of Alabamians already have medical debt in collections.

Options

Weida says negotiating bills is one option. He advises that uninsured patients request the rates insurers get.

“If you ask, (some hospitals) will give you a discounted rate based off of BlueCross, BlueShield, or Medicare, but you'll have to ask,” he said.

Cox suggests prioritizing keeping continuous health insurance, although that may be challenging for the newly unemployed.

Federal COBRA coverage is one option that includes a 60-day retroactive window after a job loss, but the premiums are often prohibitively high, about $20,600 a year for a family or $7,200 a year for a single person.

Alabamians may qualify for Medicaid if they earn less than $16,612 as individuals or $34,248 for a family of four, have a disability, or are caring for some with a disability, are pregnant, or are raising children among other criteria.

For many, the Affordable Care Act will be the best option, says Cox. It allows for enrollment up to 60 days after a job loss or significant household change.

“You should start this process as soon as possible,” she said, adding that the foundation has put out a guide for people who have lost their healthcare coverage.

There’s a catch though, to qualify, people must earn poverty-level wages. Cox says it is possible to anticipate future earnings for the year, income from stimulus checks and history of earnings to meet that requirement.

“There's going to be a lot more people finding themselves in that situation where they've never really had to think about how they're going to get their own health insurance,” she said.

To Weida, the financial outcome for people depends partly on how bad the disease is in Alabama.

“This is a major problem of underinsured, medically underinsured patients in America,” he said. “They’ll never get out of poverty with a medical bill hanging over their head.”