ROCHESTER, Minn. — With 214 Minnesotans now on life support or in need of advanced care for COVID-19, the state is at its highest ICU level for the illness since the day after Christmas 2020.

It's a troubling statistic, one made worse by the thousands of Minnesotans at risk of responsibility for hefty COVID-19 treatment costs at the end of this month.

That's when out-of-pocket payment waivers instituted in the early days of the pandemic are lifted for some policy holders.

Of five major insurers in the state who pledged to waive co-pays and deductibles for COVID-19 treatment until the end of September 2021, just three of those — UCare, Blue Cross and HealthPartners — have extended those waivers until the end of 2021.

"HealthPartners will continue to waive member cost-sharing for in-network COVID-19 treatment through the end of the year," said company spokesperson David Martinson in an email.

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"Blue Cross and Blue Shield of Minnesota made the decision back in May to extend no-cost coverage for COVID-19 treatment through the end of the year," said spokesperson Bryce Butzer in an email. "We will continue to monitor the health impacts of the COVID-19 pandemic and communicate any changes to this expanded coverage with our members before the end of the year."

The website for UCare states that it will "continue to waive cost share for COVID-19 observation or inpatient hospitalization for all members through December 31, 2021."

Other payers, however, are holding those hospitalized with COVID-19 to the terms of their policies.

"For COVID-19 treatment," as the website for United Healthcare states, "cost-sharing will be according to the member’s benefit plan. You will be responsible for any copay, coinsurance, deductible or out-of-network costs."

For Medica, which insures Mayo Clinic employees among its 1 million customers in nine states, the decision to let waivers lapse in the midst of the current hospitalization wave is a reflection of the fact that Minnesotans now have the option to get vaccinated.

"Given the broad availability of the COVID vaccine and the vaccines’ effectiveness in keeping COVID patients out of the hospital," Medica spokesperson Greg Bury said in an email, "we are not extending these policies past September 30."

Asked of concerns over worsening the burden of the pandemic given COVID-19 hospitalizations being at an all time high for 2021, Bury returned the company's focus to the availability of vaccines.

"COVID vaccines are readily available to the public," he stated, "and have been for quite some time. Vaccines are proven to prevent hospitalizations for people who contract COVID and we encourage Minnesotans to get fully vaccinated if they haven’t done so already."

Average COVID-19 ICU tab is $100K

“While many for-profit insurers ended their cost-sharing waivers for inpatient treatment in 2020, several nonprofit health plans voluntarily stepped up to support Minnesotans with cost-sharing waivers for hospitalizations that have extended well into 2021," Jocelyn Parker of the Minnesota Council of Health Plans said in an email.

"While cost-sharing may apply in some cases," Parker said, "it’s important to note that inpatient treatment continues to be covered just as any other acute illness. Minnesota-based health plans spent more than $1 billion last year on cost-sharing waivers related to COVID testing and inpatient treatment. ”

Hospitalization for COVID-19 is long and costly.

According to a recent report from FAIR Health, insurers paid out nearly $100,000 for the average hospital stay requiring complex care, a sum that was only a third of what hospitals billed.

Charges for general hospitalization treating COVID-19 averaged roughly $75,000, with insurers paying $33,000 on average

With most policies now carrying steep deductibles and co-pays, the rise in hospitalizations is likely to saddle those who recover from COVID-19 with something more than a survival story: Thousands of dollars in medical bills.

Under the terms of the Affordable Care Act, insurers cannot raise premiums on the unvaccinated. The current wave of hospitalizations, however, could signal a raising of the stakes on the unvaccinated.

The 2020 COVID-19 hospitalization wave saw almost 400 patients in the state on life support; that number crested on the last day of November.

At just over half as many patients in the ICU with COVID-19 today, the stress test for Minnesota's hospital personnel now underway is more relentless and unevenly concentrated.

Thousands of square miles in northwest and south-central Minnesota currently report zero and three staffed ICU beds respectively. The central and northeastern Minnesota regions have both surpassed 90% of their critical care capacity.

The current wave has risen continuously for two consecutive months, compared to the one-month waves of last fall and spring of 2021.

ICU use for COVID-19 in Minnesota is at a point not seen since Christmas, and has risen continuously for two straight months, compared to one-month waves in 2020 and 2021. Source: Minnesota Department of Health
ICU use for COVID-19 in Minnesota is at a point not seen since Christmas, and has risen continuously for two straight months, compared to one-month waves in 2020 and 2021. Source: Minnesota Department of Health

Deaths have not risen appreciably during this time, but at 675,400 lives lost the nation has quietly surpassed a terrible milestone, with more fatalities now due to COVID-19 than the 1918 flu.

This story has been updated to state the correct membership of Medica. It has one million members in nine states.