Originally Published: Oct 27, 2014 3:44 p.m. ET at http://www.marketwatch.com/story/if-you-get-ebola-will-it-be-covered-by-insurance-2014-10-27
The average American is more likely to get hit by lightning than Ebola- but those who do contract the virus here face a fight for survival, public scrutiny, and yes, big medical bills.
The numbers are staggering: the hospital bill for an Ebola patient will likely run between $18,000 to $24,000 a day, said Gerard Anderson, professor at the Johns Hopkins Bloomberg School of Public Health. That includes the cost of intensive care, around $5,000 a day normally, plus the cost of isolating the patient and losing revenue from the surrounding beds.
Health insurance will cover much of this, for those who have it. Just how much will depend on a number of factors, including the plan’s fine print and the hospital’s willingness to cut a deal.
Most commercial insurance plans have what’s known as an annual out-of-pocket maximum, which is a cap on patient spending on care inside the plan’s network of doctors and hospitals. (Monthly premium charges don’t count toward this total.)
Ebola care is so expensive that patients will hit their plan’s out-of-pocket ceiling almost immediately after being hospitalized, and they’ll have to pay that full amount, Anderson said. The average cap for individual bronze health plans on the Obamacare exchanges is $6,386; for silver, it’s $5,745; for gold, $4,230 and for platinum, $1,417, according to an analysis by HealthPocket, a health insurance comparison site. Employer-sponsored plans generally have lower out-of-pocket limits, but they could still run above $1,000.
Only care provided inside the plan’s network counts toward the cap. Patients receiving care far from home will likely be treated by doctors who don’t participate in their plan (and even those getting care close to home sometimes incur surprise out-of-network charges).
Even so, many plans cover out-of-network charges more fully in emergency situations, said Andrew Fitch, head of consumer engagement at NerdWallet Health. Ebola likely qualifies as an emergency, even though it has an incubation period of up to three weeks.
An uninsured Ebola patient would theoretically be on the hook for the full amount of care – a tab that could easily run into the hundreds of thousands of dollars. In practice, the hospital would likely give that patient financial assistance and charity care to avoid the PR nightmare that would come from presenting an uninsured Ebola patient with a massive bill, experts said.
The cost of quarantine
Many more Americans will be quarantined for monitoring than actually contract the Ebola virus. Who will foot the bill for their three weeks away from work?
In New York, Gov. Andrew Cuomo recently ordered a mandatory, 21-day quarantine for people returning from three affected countries in Africa who have had direct contact with people infected with Ebola. Those whose employers will not pay their salaries for those three weeks will receive financial assistance from the state, he said.
Others subject to quarantine, such as family members of an Ebola patient, might need to max out their paid leave and then take unpaid leave for the remainder, experts say.
It’s unlikely that a disability insurance policy will cover wages lost to Ebola quarantine, said Steven Weisbart, senior vice president and chief economist at the Insurance Information Institute. To qualify for disability, most policies require a medical determination that a person can’t do a job, and that doesn’t apply to an asymptomatic person confined to the home out of caution.
The federal Family and Medical Leave Act allows employees of larger companies to take up to 12 weeks of unpaid leave for a serious health condition and guarantees them a comparable job on their return. However, if workers are just told to stay home and take their temperature twice a day, “there’s a very significant question of whether that would qualify as a serious health condition,” said Shannon Farmer, a partner in the labor and employment group of Ballard Spahr in Philadelphia.
For now, most employers won’t want the negative publicity that would come from laying off someone on Ebola quarantine, Farmer said, although complications could arise if a worker who took a quarantine leave needed to take further leave in the same 12-month period to have a baby, for instance, or care for an ailing relative.
Originally Published: Oct 27, 2014 3:44 p.m. ET at http://www.marketwatch.com/story/if-you-get-ebola-will-it-be-covered-by-insurance-2014-10-27